
SFsi 



Class 
Book. 



2^AL1_ 



COPYRIGHT DEPOSIT. 



Surgical and Obstetrical 
Operations 



FOR 



Veterinary Students and Practitioners 



BY 



W(>^l/williams 



Professor of Obstetrics and Surgery in the New York State Veterinary 
College, Cornell University. 



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Embodying portions of the OPHRATIONSKURSUS of Dr. W. Pfeiffer, 
Professor of Veterinary Science in the University of Giessen. 



Published by the Author 
Ithaca, N. Y, 



PRESS OK 
ANDRUS & CHUKCH 

ITHACA, N. Y. 



THE LIBRARY OF 
CONGRESS. 

Two Copies Receive*! 

SEP 30 1903 

Cooytight Entry 
CLASS Ix. ^^ N» 

copyTb,.,. 




COPYRIGHT, 1903, BY 
\V. Tv. WILLIAMS. 






T/1 



PREFACE. 

Tlie author caused to be publislied in 1900 a l)ooklet 
entitled: " A Course in Surgical Operations by W. Pfeiffer 
and W. L. Williams." consisting of an authorized transla- 
tion of Dr. Pfeiffer's Operations-Cursus with such changes, 
omissions and additions as were deemed desirable. Three 
years of constant use, with such criticisms as have come to 
the author from others, have .served to point out desirable 
changes of so sweeping a character as to demand a practi- 
cally new treatise and to render the continuance of a formal 
joint authorship inexpedient. The author has drawn freely 
upon Dr. Pfeiffer's Operations-Cursus in the preparation of 
the text which in many chapters is practically copied there- 
from, including the illustrations, and gratefully acknowl- 
edges his profound obligations thereto. On the other hand 
nothing has been copied or extracted except it could be freely 
adopted as the author's own view, releasing Dr. Pfeiffer 
from all responsibility for the character of any of the con- 
tents. 

The volume is primarily designed for the use of the auth- 
or's classes in laboratory surgery and embryotomy in which 
the student performs the surgical operations described, on 
animals procured for the express purpo.se, under chloroform 
anaesthesia whenever possible, after which the subject is 
destroyed while still anaesthetized ; at the .same time it has 
been aimed to render the volume of the greatest possible 
value to the practitioner consistent with this plan. The 
operations included under this .scheme are necessarily limited 
to those which can be reasonably well performed on com- 
paratively sound animals of little value and regularly pro- 
curable for laboratory purposes. The ii.st covers a wide 
range and is designed to give to the student as thorough 
training as is practicable in a laboratory course and includes 
w-ell nigh all the more important varieties of confinement, 
anaesthesia, di.sinfection, sutures, bandaging, dre.s.sing and 
other adjuncts to operative work. The chapter on trephin- 



iv PREFACE. 

ing of the facial sinuses has been dealt with at length in 
order to fully and clearl}^ describe the author's method of 
operating ; a new operation for poll evil has been inserted 
and there has been included a description of some of the 
most important embryotomy operations as they are carried 
out in the laboratory by means of freshly killed, new. born 
calves which are placed in the position desired, in the arti- 
ficial uterus of a specially prepared skeleton. 

Generally but one method of operating is described, the 
one chosen being that which in the author's experience has 
proven the most valuable in actual practice, and no opera- 
tion has been introduced purely for practice but each one 
has been tested and known to have practical value. 

Where two methods of operating are given, the^^ are 
inserted because each has definite points of superiority over 
the other and one method may be specially applicable in a 
given case, another in a different patient where the same 
operation is to be performed as for example, a milk cow is 
best spayed through the vagina while a heifer must be 
operated on by an incision through the abdominal walls. 

Considerable stress has been laid upon the surgical an- 
atomy of the parts involved in each operation ; some uses of 
the various operations are mentioned ; some of the chief 
dangers of each are pointed out and in some cases references 
to literature upon the operation or the diseases for which the 
operation is designed, are cited. 

The figures in the text except Nos, 5, 10 and 11, and the 
Plates Nos. I, II, VIII, X, XII, XIV, XVII, XVIII, 
XXI, XXII, XXIII, XXV, XXVIII and XXIX are from 
Dr. Pfeiffer's Operations-Cursus ; Plate No. Ill was drawn 
by Dr. C. F. Flocken, Bureau of Animal Industry, Wash- 
ington, D. C, and the remaining Plates were drawn under 
the direction of the author by Mr. C. W. Furlong, In- 
structor in Industrial Drawing and Art in Sibley College, 
Cornell University. 

W. ly. WILI.IAMS. 

Cornell University, October, igoj. 



CONTENTS. 
I. 

I. OPERATIONS ON THE HEAD : 

Page. 

1. Extraction of Teeth i 

2. Repulsion of Teeth n 

Trephining the Facial Sinuses 18 

3. Trephining of the Frontal Sinuses 21 

4. Trephining the Maxillary Sinuses 33 

5. Trephining the Nasal Fossae__ 36 

6. Poll Evil Operation 37 

7. Ligation of the Parotid Duct_ 41 

8. Entropiuni Operation 46 

9. Staphylotomy 47 

10. Trifacial Neurotomy 48 

II. OPERATIONS ON THE NECK : 

11. Opening the Guttural Pouches 53 

12. Tracheotomy 5^ 

13. Arytenectomy 61 

14. Intra-tracheal Irrigation 66 

15. Intravenous Injection 67 

16. a. Phlebotomy with Fleams 69 

b. Phlebotomy with Lancet 70 

c. Phlebotomy with Trocar 71 

17. Ligation of the Carotid Artery 71 

18. CEsophagotomy 76 

III. OPERATIONS ON THE TRUNK AND ON THE GENITAI, ORGANS : 

19. Puncture of the Chest 78 

20. Puncture of the Intestine 79 

21. Subcutaneous Caudal Myotomy Si 

22. Caudal Myectomy for Gripping of the Reins 83 

23. Amputation of the Tail 88 

24. Urethrotomy 90 

25. Amputation of the Penis 93 

26. Vaginal Ovariotomy in the Mare 97 

27. Vaginal Ovariotomy in the Cow 107 

28. Ovariotoni}^ in the Cow by the Flank 109 



vi CONTENTS. 

29. Ovariotomy in the Bitch by the Flank no 

30. Ovariotomy in the Bitch by the Linea Alba 117 

31. Ovariotomy in the Cat 118 

IV. OPERATIONS ON THE EXTREMITIES : 

32. Tenotomy of the Flexor Tendons of the Foot 119 

33. Tenotomy of the Peioneal Tendon (Stringhalt Operation) 121 

34. Tenotomy of the Cunean Tendon (Spavin Operation) 125 

Neurotomy 129 

35. Digital Neurotomy 132 

36. Plantar Neurotomy 137 

37. Median Neurotomy 141 

38. Ulnar Neurotomy 147 

39. Sciatic Neurotomy 153 

40. Anterior Tibial Neurotomv 163 

41. Resection of the Lateral Cartilages 165 

42. Resection of the Flexor Pedis Tendon 172 

43. Amputation of the Claws of Ruminants 174 

44. Bayer's Sutures 179 

II. 

EMBRYOTOMY OPERATIONS I 

45. Cephalotomy 183 

46. Decapitation 185 

47. Subcutaneous Amputation of Anterior Limb 185 

48. Amputation at the Humero-radial Articulation 187 

49. Detruncation 188 

50. Destruction of the Pelvic Girdle, Anterior Presentation 192 

51. Amputation of the Limbs at the Tarsus 196 

52. Intra-pelvic Amputation of the Posterior Limbs, Breech Pre- 

sentation 200 

53. Evisceration of the Fetus 209 



INTRODUCTION. 

Many details must be omitted in the succeeding text which 
are of importance in each operation, Init which, if inserted, 
would render the volume unwieldy in size for the purpose 
designed. 

These details are in a measure alike in each case, and it is 
assumed that the student has already familiarized himself 
with them. The more important of these may be summa- 
rized as follows : 

1. The subject should bo securely confined in each case 
as directed, because the method designated has been found 
effective in the operation under description, and serves to fix 
the relations of the parts in such a way as to conform to the 
surgical anatomy of the region as outlined in the text. It 
is to be constantly borne in mind that a change in the atti- 
tude of the animal is capable of causing profound alterations 
in the relations of parts which may greatly embarass the 
operator, or even prevent his carrying out the operation 
according to the technic given. In securing an animal for 
operation we must confine the whole body in a way that will 
suf^ciently control movements and will insure safety to the 
patient and operator ; the part to be operated upon must be 
so fixed as to properh- limit its motion and in a position to 
afford the greatest facility for the carrying out of the opera- 
tion according to the best technic known. 

2. Anaesthesia should be carefully carried out everywhere 
possible, because in addition to the humane sentiments in- 
volved, the resulting perfect control of the animal is an 
essential in aseptic or antiseptic surgery. The student 
should make a careful study of anaesthesia in these exercises 
and acquire invaluable experience and confidence for use in 
actual practice. 

3. Disinfection must be scrupulously applied in every de- 
tail since upon its effectiveness must hang the verdict of 



viil INTRODUCTION. 

success or failure as measured b}^ moderu surgical kuowl- 
edge. The operator's hands and, if need be, his arms 
should be thoroughly scrubbed with a stiff brush in hot 
water with soap for a period of fifteen minutes, the finger 
nails well trimmed and cleansed, and all dirt and old epider- 
mal scales removed. The parts may then be disinfected b}^ 
immersing in a hot concentrated solution of permanganate 
of potassium for ten minutes and then decolorized in a strong 
solution of oxalic acid in sterile water. Or the hands may 
be disinfected after the washing with soap and water by im- 
mersing and scrubbing them for ten minutes in a i to looo 
solution of corrosive sublimate, but in order to make this 
thoroughly effective the solution needs be alcoholic, or the 
hands should first be immersed in alcohol, ether, or other 
substance capable of dissolving fats and permitting the dis- 
infectant to penetrate the sebaceous glands. Great care 
should be exercised by the student to not touch any object 
after the hands have been disinfected for the operation unless 
it has been disinfected or sterilized, or in case it becomes 
necessary to touch objects not sterile, the disinfecting process 
should be repeated before proceeding further with the oper- 
ation. This constitutes one of the most difficult of all details 
for the beginner to acquire, and each failure should be 
remedied by repeating the disinfection over and over until 
the habit of maintaining effectual sterilization is acquired 
and fixed. 

The operation field should always be carefully shaved be- 
fore beginning the operation, and the shaved area should 
always be very ample, so as to insure against contamination 
from adjacent hairs, as well as to give a clear view of the 
field. The area should then be disinfected in a reliable 
manner, that advised for the operator's hands serving as a 
type. Whenever circumstances will permit the operation 
field should be kept in an antiseptic bath or pack for twenty- 
four hours prior to the operation in order that the deeper 
parts of the skin, especially the hair follicles and sebaceous 



INTRODUCTION. ^^ 

glands, shall become thoroughly disinfected, a process well 
nigh impossible in a short period. 

The suturing, dressing and bandaging of the wound 
should be carried out carefully in every case and no opera- 
tion left without completing it in the best manner possible. 
The student should make each operation as real as possible 
and not omit any detail even if he thinks he already knows 
it sufficiently well as the repetition of a supposedly familiar 
detail serves an important purpose in the fixing of a habit 
which is inestimably more valuable to the surgeon than any 
theoretical knowledge of technic. 

The safe surgeon is he who has so accustomed himself to 
the technique of asepsis and antisepsis that he carries them 
out rigidly in an automatic manner and can leave his atten- 
tion riveted on the surgical problems before him. 

The student who consults his interests will go yet farther 
and prior to undertaking any operation on the living subject 
will study the regional anatomy of the part on the cadaver 
and learn therefrom all tiiat he can of the structure of tlie 
part which he must finally complete upon the living animal. 
No dissection of the cadaver can ever teach true surgical, 
.structure as the dead tissues can not be like the living, but 
such dissection can and does give great aid and should 
be pursued as far as it can lead and enough will still remain 
to be learned on the living subject. 

He should further take occasion to study in connection 
with each operation the object or objects for which it is per- 
formed in practice, its effect on the diseased or other parts, 
the untoward results to be anticipated, etc. 

Suggestions occur from time to time in the text designed 
to aid the student in these lines and help weave connecting 
bands between the operation, its objects and results. 

Surgical operations are in themselves valueless or worse 
and acquire value only when properly correlated to disease 
and skillfully performed. 



Surgical and Obstetrical Operations. 



I. SURGICAL OPERATIONS. 



OPERATIONS ON THE HEAD. 

I. EXTRACTION OF TEETH. 

Pirates I and II. 

Prefatory remarks. The grinding teeth of the horse 
consisting of three molars and three premolars in each row 
are of such dimensions and attachments that their removal 
in case of disease or defect often presents difficulties of no 
small degree. 

These teeth attain their greatest size at the time of erup- 
tion and most of the tooth remains firml}^ imbedded in its 
alveolus while a very shallow crown projects into the buccal 
cavity. The teeth are gradually pushed out of their alveoli 
as their crowns are worn away with age and the proportion 
of the intra- to the extra-alveolar part gradually decreases 
until in very old animals the alveoli become obliterated and 
the last vestige of what was once the apex of the fang rests 
insecurely in the buccal mucous membrane. 

The facility with which teeth may be extracted increases 
as the age of the animal increases, being easily drawn with 
forceps in the old, while in case of freshly erupted teeth in 
the young horse we have not been able to extract them with 
forceps of any kind, except in those cases where they have 
become somewhat loosened as a result of disease or accident. 
When aberrations in development occur, leading to the for- 
mation of dental tumors or odontomes the possibility of ex- 
traction by means of forceps is frequently wholly excluded 
and in cases where dental disorder has led to empyema of 
the facial sinuses, even if the tooth may be drawn by means 
of forceps, further operation is generally necessary, in order 



2 EXTRACTION OF TEETH. 

to assure a prompt recovery, by the removal of the effects 
of the disease of the tooth. 

The removal of molars may therefore involve extraction 
with forceps, trephining the dental alveolus and repulsion 
of the tooth and trephining of the sinuses because of em- 
pyema or other pathologic conditions referable to the dental 
affection ; consequently all of these should be studied as re- 
lated topics. 

Instruments. Extracting forceps, fulcra of various 
sizes, mouth speculum with abundant lateral working room, 
exporteur forceps, tooth pick, splinter forceps, reflecting lamp. 

Technic. In simple cases with a quiet animal the pa- 
tient may be sufficiently confined by being backed into a 
corner or very much better by securing in stocks. In com- 
plicated cases or ver}^ resistant animals it is best to place 
upon the operating table or in default of this, cast and secure 
in lateral decubitis on the opposite side to the affected tooth. 

Apply the speculum and identify the diseased tooth by 
manual exploration ; determine if the tooth is of unnatural 
size or form, if it is loose, if the gums are separated from the 
neck at any point, if it is out of line with the other teeth in 
the row, if it is painful to tlie touch, if it be split, etc. An 
external tooth fistula or a tumefaction over the affected 
member may aid in distinguisliing it. Aid ma}^ also be had 
by illuminating the mouth with a reflecting electric or other 
lamp. 

Remove any accumulations of partially masticated food by 
means of the toothpick or witli the fingers. 

For extracting molars use forceps acting as a lever of the 
first class, with a fulcrum having a plane and a convex sur- 
face ; for the premolars use forceps acting as a lever of the 
second class. In case of tlie superior premolars some prefer 
forceps bent on the flat as shown in Plate II, because if 
straight the forceps handles strike against the superior in- 
cisors and hinder the deep fixation of the forceps jaws upon 
the tooth crown. 



EXTRACTION OF TEETH. 3 

In applying the forceps to the tooth h.ave an assistant draw 
the tongue well out at the commissure of the lips on the side 
opposite to the affected member and introducing one hand 
into the mouth, place the index finger on the posterior 
border of the diseased tooth and with the other hand push 
the opened forceps backwards upon the tooth row until they 
reach the finger, then firmly grasp the affected tooth with 
the instrument, pressing the jaws down as deeply as possible 
against the alveolus. In many cases the diseased tooth can 
be clearly seen especially with the aid of the reflecting lamp 
and the forceps readily applied with visual aid and is fre- 
quently preferable to the guide of touch. Withdraw the 
free hand from the mouth, grasp the handles with both 
hands and loosen the tooth in its alveolus by establishing 
and maintaining as long as necessary a gentle to and fro 
lateral movement. The tooth is thus loosened in its alveolus 
by causing it to revolve very slightly back and forth on its 
long axis. When the tooth has become well loosened, as 
indicated by its moving with the forceps and by the audible 
crackling sound caused by the passage of air bubbles to and 
fro through the blood and lymph in the alveolus ; maintain 
the forceps in position with one hand and with the other 
introduce the fulcrum as far back as possible in the case of 
molars and place it with the plane surface resting upon the 
crowns of the teeth as shown in Plate I. The fulcrum 
needs be held firmly in place in order to prevent it from 
gliding forward under pressure. 

The tooth fang is extracted by forcing the handles of 
the forceps toward the jaw in which it is located, so that 
as it is gradually drawn out the forceps tend to glide over 
the convex surface of the fulcrum in a way to permit the 
tooth to emerge from the alveolus in the direction of the 
long axis of the latter. By referring to Plate III it will be 
seen that the axes of the different teeth vary, that of the 
molars being obliquely forwards toward the incisors while 
the crowns of the premolars are directed obliquely back- 



Plate I. 

Extraction of Teeth. 

Sagittal section through the oral cavity, show- 
ing plan for extracting the first inferior molar, 
viewed from within the mouth. 



EXTRACTION OF TEETH. 7 

wards from the incisors. The slant of the teeth is most 
marked at the ends of the row and at the middle they 
acquire a practically perpendicular position. In drawing 
the last molar the forceps will generally strike against 
the opposite row of teeth before the tooth has com- 
pletely emerged from its socket and in order to complete its 
removal it may be necessary to take a deeper hold with the 
forceps or remove with the exporteur forceps or with the 
fingers. In young horses where the teeth are very long we 
have found it impossible to complete the extraction until the 
tooth had been divided transversely by means of the tooth 
cutting forceps. 

With the premolars the fulcrum is placed beneath the ex- 
tension beyond the jaws of the forceps which through its 
fulcrum then rests upon the grinding surface posterior to the 
diseased tooth and permits it to be withdrawn obliquely from 
before backward in its normal line of direction. 

The dangers in the extraction of teeth are chiefly : 

1. The fracture of the tooth crown leaving the fang still 
fixed in the alveolus, a danger not infrequently unavoidable 
when the crown has become greatly weakened by disease so 
that it wants the power of resistance necessary to its extrac- 
tion ; under most other conditions it may be largely guarded 
against by the careful securing of the patient in a manner 
to effectively prevent sudden throwing of the head while the 
forceps are applied, and by using good judgment in the 
amount of force used while loosening the tooth in its alveolus. 

2. Fracture of the alveolar walls is an accident which may 
generally be prevented by proper care in the application of 
force and the avoidance of au}^ attempt to extract a tooth 
when the existence of an enlargement of the far.g is apparent 
or .suspected. 

3. The tooth may slip from the forceps into the pharynx 
and be swallowed, an accident avoidable by inserting the 
hand into the mouth along with the forceps as the tooth be- 
gins to emerge and if need be grasp it with the fingers. 



Plate II. 

Extraction of Teeth. 

Sagittal section through the walls of the oral 
cavity illustrating plan for extracting the sec- 
ond superior premolar. 



REPULSION OF TEETH. Ii 

2. REPULSION OF TEETH. 
PI.ATE III. 

Uses. The removal of molars, pre-molars, tooth fangs 
from which the crowns have been broken away, alveolar 
odontomes. etc.. which can not be removed safely by means 
of the forceps. 

Instruments. Razor, convex scalpels, trephine, bone 
gouge, Luer's sharp bone forceps, light and heav}' bone 
chi.sels, mallet, tooth punch, curette, compression artery 
forceps, scissors, needles, thread, absorbent cotton, antiseptic 
gauze, extracting forceps, splinter forceps, dressing forceps, 
tenacula, metal probe, mouth speculum. 

Technic. Secure the animal in the lateral recumbent 
pcsition with the affected side up. The operating table 
affords by far the best means for securing for the conven- 
ience and safety of operator and patient. If the sinuses are 
.so involved as to make possible the inhalation of jnis, blood 
or other injurious matter, perform tracheotomy in ample 
time to avert danger. Anaesthetize. Shave and disinfect 
the operative area and trephine according to the method 
described in the following chapter down through the alveolar 
plate immediately over the fang of the affected tooth. Avoid 
dulling the trephine by .striking it against the tooth fang 
itself. If a tooth fistula exists the identity of the affected 
tooth is best determined by passing a metallic probe through 
the fistula against the di.seased fang while one hand is pa.ssed 
into the mouth and the location of the probe ascertained. 
Care should be exercised in trephining to not injure the ad- 
joining teeth. After removing the disc of bone isolated by 
the trephine, control all hemorrhage and then enlarge the 
opening and remove the bony tissues till the tooth fang is 
bared its entire width. Insert a scalpel between the bone and 
.soft tissues at the margin of the trephine opening nearest the 



12 REPULSION OF TEETH. 

mouth and with one hand in the oral cavity with the fingers 
resting upon the alveolar border on the lateral side of the 
tooth to serve as a guide, push the scalpel along between 
the bone and soft tissues until it emerges from the gums 
alongside the affected tooth and extend this incision back- 
wards and forwards until the soft tissues are completely de- 
tached from the alveolar wall over the entire area of the 
diseased member. With a light, narrow bone chisel cutaway 
and remove the entire external alveolar plate throughout 
the extent of the tooth, from the oral margin of the trephine 
opening into the mouth cavity. Hold the chisel so that the 
outer edge is inclined from the affected tooth toward the 
adjoining one, thus making a bevelled channel through the 
alveolar plate which tends to loosen and detach the section 
of the alveolar wall to be removed without injury to that 
adjoining. Drive the chisel for a short distance only on one 
side and then apply it to the other side in order to detach 
but small pieces of bone at one time avoiding the detachment 
of large sections of the plate at once and having it extend to 
neighboring alveoli. With gouge and chisel remove all 
remnants of bone over the lateral side of the tooth laying it 
completely bare as shown in Plate III. The soft tissues of 
the part should not be disturbed beyond the removal of the 
circular piece over the disk of bone removed by the trephine 
and detatching them from the portion of bone to be chiseled 
away. When the tooth has been bared so that every part of 
its lateral surface can be seen or felt, the punch may be placed 
against the end of the fang, a few firm, quick blows given 
with the mallet, so directed that the force is in a line with 
the long axis of the tooth, driving it into the mouth where 
it is seized by the forceps or the hand and removed. If it 
is not readily and safely dislodged in this way, place the 
heavy bone chisel against it and with the aid of the mallet 
comminute the tooth by breaking it transversely and splitting 
it longitudinally, in which process the fragments are gener- 



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1 6 REPULSION OF TEETH. 

ally loosened and can then be readily removed with the aid 
of the gouge or forceps. Remove carefully all fragments of 
"tooth or of loosened bone, cleanse and disinfect the wound, 
pack with iodoform gauze and dress daily. 

In cases where a fistulous opening remains after repulsion 
of molars in the usual manner without the removal of the 
alveolar wall, or if a tooth has been drawn by means of the 
forceps and the alveolus fails to heal, the bony plate should 
be removed in the same manner as indicated for the removal 
of the teeth. 

Dangers, Wounding of neighboring teeth, fracture of 
the inferior maxilla, fracture of the bony palate. 

Wounding of the adjoining tooth is to be avoided chiefly 
b}' carefully locating the fang of the affected one and 
placing the center of the trephine as exactly as possible over 
the center of the tooth, b}^ using a trephine not exceeding 
2 to 2,5 cm, in diameter and cautiously trephining through 
the compact layer of the external plate only, removing the 
cancellated tissue with the gouge and extending the opening 
in the desired direction after the outlines of the tooth fang 
have been clearl}^ determined. If an adjoining fang is 
w^ourided the tooth should be removed as it will not heal but 
will result in a permanent tooth fistula. 

The fracture of the alveolar walls of the inferior maxilla is 
to be constantly guarded against by being cautious to see after 
each stroke on the punch that it has not slipped inward along 
the median side of the tooth, pressing the internal plate awa}^ 
from the tooth row and tending to produce a longitudinal 
fracture nearl}' or quite as long as the dental arcade. Careful 
digital exploration in the mouth may discover this fracture 
while still " simple " but a stroke or two more will convert it 
into the very much more serious " compound " fracture open- 
ing into the oral cavity. Keeping one hand constantly in the 
mouth at the point of impact is alwa3\s desirable as a precau- 
tionary measure. Transverse fracture of the tooth w^hile 



REPULSION OF TEETH. 17 

yet ill situ b\^ means of the bone chisel, as above described, 
is a great safeguard against this injur}' b}- lessening the force 
required in repulsion and by the removal of the tapering 
fang, vvhicli then leaves a more secure base for the punch to 
act upon. It should never be forgotten that the impact from 
the punch must always be as nearly parallel to the long axis 
of the tooth as is possible. 

The fracture of the superior maxilla and bony palate is 
not so probable as the preceding and is preventable by mod- 
erate care in the baring of the tooth before punching, by 
connninution of the tooth in bad cases, b}' the careful ad- 
justment of the punch and applying the force in the proper 
direction. 

Literature. Odontomes, Sir Bland Sutton, Jour. Comp. 
Med. and Vet. Arch. Vol. XII, p. i ; A Clinical Study of 
Odontomes, W. L. Williams, Am. Vet. Review, Vol. XV, 
p. I ; Notes on Odontomes, do ; Am. Vet. Rev. Vol. XXIII, 
p. 82 and Oest. Mon. Thierheilkunde, Bd. XXIV, s. 122. 



1 8 TREPHINING OF THE FACIAL SINUSES. 



TREPHINING OF THE FACIAL SINUSES. 
PI.ATES IV, V, VI, VII. 

Prefatory Note. The facial sinuses of the horse consti- 
tute an exceedingly intricate and extensive group of cavities, 
communicating more or less freely with each other and with 
the exterior through the medium of the upper air passages, 
of which they are to be regarded as a part. 

Their arrangement and relations permit them to frequently 
become the seat of, or central figure in many forms of disease 
which require for their differential diagnosis, amelioration or 
cure, the operation known as trephining. Their extent and 
relations to each other and to surrounding parts varies 
greatly with age and may be profoundly changed as a result 
of disease, amounting not infrequently in the frontal, 
superior and inferior maxillary sinuses ceasing to exist as 
separate cavities and becoming merged into one vast diverti- 
culum. Similar changes may occur in the nasal and tur- 
binated cavities. The general position, extent and relations 
of these are indicated by Plates IV, V, VI and VII. 

The uses of trephining are in a measure common to all 
the cavities involved and are chiefly for the relief of 
empyema of the cavities involved, necrosis of the bony or 
cartilaginous walls, tumors of various kinds, especiall}/ dental 
tumors in the young and malignant growths in the old, 
foreign bodies in the sinuses, differential diagnosis of diseases 
of this region, etc. 

Veterinarians trephine the sinuses by two fundamentally 
different plans; with, and without excision of the cutaneous 
disk corresponding to the piece of bone removed. The first 
is generally used in Great Britain and North America while 
the last is the prevailing method in continental Europe and 
other parts of the world. The reasons for these variations in 
method have not been o:iven so far as we know. To us 



TREPHINING OF THE FACIAL SINUSES. 19 

there seem to i)e adequate reasons for preferring the excision 
of the cutaneous disk. We regard as the chief considera- 
tions in an operation the following : the avoidance of infec- 
tion ; the prevention of pain during tlie operation or the 
after-treatment ; the reduction of the scar to a minimum ; 
rapidity and certaint}' of recover}' ; convenience in operating 
and dressing. Infection is largely dependent, aside from 
aseptic operation and protective dressing, upon the area of 
the wound, the facilit}^ for maintaining cleanliness and the 
degree of disturbance to the tissues while being dressed. 
The wound area in the bone is alike in all cases but that in 
the skin varies greatly. Jf we take as a type the usual Ger- 
man technic and compare it with that given below we would 
find the wound areas approximately as follows : in the Ger- 
man method, an incision 2.7 in. (7 cm.) long which assuming 
that the skin is y\ in. thick would yield an area of 2.7" X 2 = 
5.4" X y^" = I sq. in. The subcutem is then separated 
from the periosteum and the skin drawn apart far enough to 
admit of the insertion of, say, a ^" trephine giving 2 triangles 
each having a base of 2.7" in. and a perpendicular of yV"- 
or an area of 2.7" X yVr" =1.2 sq. in. ; thus giving a total 
wound area of 2.2 sq. in. Assuming the same thickness of 
skin and the same size of the trephine in the operation as 
given below we have only the wound caused by the circular 
incision which would measure \" X 3.1416^2.7" in cir- 
cumference X yg" = .44 sq. in. or proportionately the wound 
area in the soft tissues in the German operation to that given 
below would be as 5:1. 

It is ver}' evident that the technic below given affords 
immeasureably better facility for maintaining cleanliness in 
the wound and with a minimum amount of insult to the 
tissues in the process of dressing. 

The amount of pain caused in the operation would depend 
chifly on the extent of the skin incision which is equal in 
the two plans so that the only difference Vv'ould be in the dis- 



20 TREPHINING OF THE FACIAL SINUSES. 

section of the skin from the bone in the German operation. 
Tlie pain cansed in dressing mnst be greater in the German 
method because the detached, overiianging skin must be 
moved and disturbed each time causing pain and inviting 
infection. The question of pain must ahvdys be seriously 
considered as it not only affects the time required for dressing 
a7id its efficacy, but has an important relatioJi to the docility 
of the animal after recovery, some horses having their dis- 
positions perjnanently ruined by the irritation due to the oft 
repeated painful dressing of zvounds. 

The cicatricial contraction of the tissues of the horse is 
so great that the removal of a circular disk of skin /s" to 
i^" in diameter on the face does not leave a visible scar so 
that the question of blemish falls back upon that of infec- 
tion which we have asserted above is far more probable by 
the German method. 

The rapidity and certainty of recovery are dependent on 
considerations above discussed. The removal of the cuta- 
neous disk is certainly easier and quicker than the other 
method. The convenience for dressing is evidently superior 
by the English and Amercan method. 

The opening of the maxillary sinuses into the nostrils is 
based upon the surgical principle that suppurating cavities 
should be provided with ample drainage from the most de- 
pendent part. The direction to leave the external wound 
open may at first thought seem antagonistic to general sur- 
gical principles but it should be remembered that the wound 
consists only of the incision through the skin, connective 
tissue and bone and that any plug which we can put in this 
opening can only serve to dam the secretions of the cavity 
back and can not prevent it from coming in contact with the 
wounded surface. It must further be regarded that the 
respiratory mucosa of the upper air passages are not irritated 
or injured in any manner so far as we can observe clinicall}' 
by the direct admission of air into them through a trephine, 
or other artificial opening. 



TREPHINNIG OF THE FRONTAL SINUSES. 21 



3. TREPHINING OF THE FRONTAL SINUSES 

Uses. Fracture of tlie bony walls, necrosis, tumors. 

The ample communication below with the superior maxil- 
ary sinuses prevents the accumulation of pus or fluids in the 
frontal cavities even if formed therein unless the opening 
between the superior maxilary sinus and tlie nasal fossa at N, 
Plates V and VI becomes blocked, preventing the escape 
of fluids through the latter and causing them to fill the 
superior maxilary sinus and then back up into the frontal. 
In case of empyema of the frontal sinus, trephining does not 
give full relief but calls for a repetition of the operation on 
the maxilar}' sinuses also. 

Instruments. Razcjr, scissors, convex scalpels, artery 
forceps, tenacula, probe, trephine, curette, gouge, Luer's 
sliarp bone forceps, hammer, chisel, bone screw, lens-shaped 
bone knife, probe-pointed bistoury, dressing forceps, disin- 
fecting and dressing materials. 

Technic. Operate on the standing animal with the aid 
of the twitch or secured in stocks, with local anaesthesia or 
secure on the operating table or cast in lateral recumbency on 
the sound side. Clip and shave the hair from the region of 
the frontal bone on a level WMth the superior border of the 
orbital cavity as indicated in Plate IV and disinfect the area 
carefully. Within the shaved and disinfected area locate the 
point for trephining, F, Plate IV, so that the inferior border 
of the opening will be on a level with the superior border of 
the orbital cavity at the dotted line below F and the inner 
margin about i cm. from the median line of the face. With 
a heavy convex scalpel make a circular incision as large as 
the area of the trephine, directly through the skin, subcuteni 
and perio.steum down to the bone and remove in one piece 
the entire mass of encircled soft tissues by seizing the skin 
with a tenaculum and forcibly separating the periosteum 



Plate IV. 

Trephining the Faciai. Sinuses. 

F, opening inlo frontal sinus ; N, opening 
into nasal sinus ; SM, opening into superior 
maxillary sinus ; IM, opening into external por- 
tion of inferior maxillary sinus ; IM^, opening 
into the median portion of the inferior max- 
illary sinus. 




im' 

- — — - IM 

/I 



TREPHINING OF THE FRONTAL SINUSES. 25 

from the bone with a scalpel or bone scraper. Control the 
hemmorhage. With the center-bit extended place the tre- 
phine accurately upon the denuded area, perpendicular to 
the surface of the bone, and by revolving it to and fro force 
the center-bit into the bone and continue until the trephine 
has cut a distinct furrow, when the center-bit should be 
withdrawn and the operation continued, being careful to 
maintain the trephine perpendicular to the bone. The ope- 
ration is facilitated by grasping the shaft of the trephine be- 
tween the thumb and fingers of one hand, constituting a 
support in which it can glide back and forth. Tiie pressure 
under which the sawing is carried out must not be too great. 
When the bony plate which has been sawed around begins 
to loosen, remove the trephine and insert the bone screw 
into the centerbit opening and break out the piece of bone 
or pry it out with tlie bone gouge or chisel. Smooth any 
uneven edges of bone with the lens-shaped knife. The ab- 
normal contents of the frontal sinus can now escape through 
the opening or be removed with the curette, forceps or scis- 
sors, and the cavity irrigated with an antiseptic fluid. Leave 
the trephine wound entirely open and dress daily with anti- 
septics. The frontal sinuses are in free communication with 
the superior maxillary and with the superior turbinated bone 
of the .same side so that indirectly the irrigating fluid can 
escape through the nasal opening b}^ way of the maxillary 
.sinus or of a perforation through the superior turbinated 
bone. 

In order to prevent the aspiration of the contents which 
are generally purulent, or may consist of blood or irri- 
gating fluids, and to facilitate their escape, irrigation 
must be carried out with the poll elevated and the head 
flexed. 

By .studying Plates IV and V it will be seen that any 
collection of pus or other disease products at F would 
result in poor drainage so far as may be obtained by 



Plate V. 

Trephining the Facial Sinuses. 

Cross section of the left side of the head of an 
aged horse at the second molar, seen from the 
front, F, frontal sinus ; N, nasal sinus, oppo- 
site the communication between the nasal and 
inferior maxillary sinuses ; IM, lateral portion 
of inferior maxillary sinus ; IM^, median portion 
of inferior maxillary sinus ; SM, superior max- 
illary sinus ; NF, superior maxillary division of 
trifacial nerve in its bony conduit ; SZ, subzygo- 
niatic artery ; P, palatine artery ; M2, second 
molar. 



TREPHINING OF THE FRONTAL SINUSES. 29 

trephining through the external wall only, and consequently 
in order to complete the drainage aside from that through 
the superior maxillary sinus an artificial communication be- 
tween the frontal sinus and nasal fossa ma}'' be made at ST, 
Plate VII, by first making a second trephine opening op- 
posite that point near the median line and then breaking 
through the thin walls of the turbinated bone by means of 
a probe or other suitable instrument and enlarging the open- 
ing sufficiently with the probe pointed bistoury or with the 
finger. In order to prevent aspiration of fluids, the animal 
must be allowed to get up immediately or if under anaes- 
thesia a trachea tube should be inserted sufficiently early to 
avoid danger. Thread a long probe with a heavy silk suture 
about 75 cm. long and inserting it through the trephine 
opening into the nasal passage draw it out through the 
nostril and removing the probe attach a strip of gauze 
75 cm. long to one end of the suture, draw it out through 
the nostril and tie tlie ends of the gauze together on the side 
of the face to prevent dislodgement. Retain the gauze 
in position for about forty-eigiit hours to insure the per- 
manency of the opening tlirough the turbinated bone. In 
case of severe hemorrhage the cavity can be tamponed for 
twenty-four hours with a long strip of gauze which may 
be secured if necessary by suturing to the lips of the wound. 
In practice the operation can be best carried out generally 
with the animal in the standing position the operative area 
being first anaesthetized by the use of cocaine or by inducing 
artificial oedema. In the standing position we largely avoid 
the danger of aspiration of fluids and the hemorrhage is 
greatlv lessened. 



Plate VI, 

Trephining the Facial Sinuses. 

Cross section, slightly oblique, through left 
half of head at fiist molar in a two year colt. 
F, frontal sinus ; N, nasal sinus at point of com- 
munication with the inferior maxillary sinus, 
IM ; IM^ median portion of inferior maxillary 
sinus; SM, superior maxillary sinus ; Mi, first 
molar ; M2, second molar ; P, palatine artery ; 
SZ, sub-zygomalic artery. 



N-4 



IM- 



— rsF 



p — . 




— SM 
Ml 

— sz 

na 






i^K^ 



TREPHINING THE MAXILLARY SINUSES. 



4. TREPHINING THE MAXILLARY SINUSES. 

Uses. Empyema, diseased teeth, odontomes, tumors. 

Instruments. Same as for the frontal sinuses. 

Anatomically there are two maxillary sinuses, superior 
SM, and inferior IM, Plates IV, V, and VI, having a thin 
imperforate bony partition between them. This partition 
shifts somewhat in position with age and in case of disease 
undergoes profound changes in location and is frequently 
totall}^ obliterated in cases of empyema, dental cysts and 
other affections, so that clinically in many cases its location, 
existence or non-existence is of scant interest. If present, 
good drainage of the superior sinus usually demands its 
surgical destruction so that most authors advise trephining 
directly over this partition in order to open the two sinuses 
simultaneously. In extensive disease the prior destruction 
of the partition renders such an operation superfluous ; in 
limited disease the opening of both cavities is ill advised. 
The partition should be ignored in operating for extensive 
di.sease and the trephine opening be aimed at the probable 
focus of disease and, if missed, it should be located through 
the primar}^ or what now becomes an exploratory opening 
and a second operation made to directly reacli the seat of the 
affection and if need be, yet a third to secure proper drain- 
age. Shave and disinfect as much of the area as may be re- 
quired bounded above by the inferior border of the orbital 
cavity, laterally by the zygomatic ridge, inferiorly by the 
lower end of the zygomatic ridge and medianwards by the 
middle line of the face. Determine the proper point for 
operation by percussion or otherwise. If it is desired to 
enter only the superior maxillar}' sinus, SM, Plates V and 
and VI, locate the opening immediateh' beneath the orbital 
cavit}^ and in front of the zygomatic ridge, SM, Plate IV, or 
at any point directly beneath this to within about 3 or 4 cm. of 
3 



34 TREPHINING THE MAXILLARY SINUSES. 

the inferior end of the zygomatic ridge at about the level of 
the dotted line IM'. In order to penetrate the inferior 
maxillary sinus the trephine opening needs be located just 
in front of the lower end of the zygomatic ridge at IM, Plate 
IV, or on a line obliquely upwards therefrom as far as the 
furrow marking the suture between tiie maxillary and nasal 
bones at IM'. The trephining is carried out as described 
for the frontal sinuses. After the trephine opening has been 
made remove any purulent collection or tumors or carry out 
any other necessary operation in the affected sinuses and 
after cleansing, if the trephine opening does not insure per- 
fect drainage of the lateral sac, either lower the opening 
already made by cutting away its inferior border with the 
bone forceps or make a second trephine opening at the neces- 
sary point. The median portion of the sinuses on the 
median side of the bony conduit of the trifacial nerve NF, 
Plates V and VI, can not be drained properly through these 
openings SM and IM, Plate IV, and provision for their 
drainage must generally be made by making a trephine open- 
ing into the inferior maxillary sinus at IM', Plate IV, and 
then make an opening 3 to 5 cm. in diameter through the in- 
ferior turbinated bone at IT, Plate VII, either with the 
finger, probe-pointed bistoury, or other suitable instrument, 
and inserting through this opening a long and thick strip of 
gauze which is brought out through the nostril and the ends 
tied together on the side of the face to prevent displacement. 
Retain this in position renewing daily until the permanency 
of the opening is assured. 

If the partition between the two sinuses is intact it will be 
necessary to destroy it immediately above IM', Plate IV, in 
order to drain the median portion of the superior maxillary 
sinus if that is required. If a molar has been removed and 
in so doing the bony wall leading down from the nerve con- 
duit NF, Plates V and VI, to the fang of the molar has been 
destroyed in the operation, sufficient drainage may be af- 



TREPHINING THE MAXIL LARY SINUSES. 3 5 

forded into the mouth and the opening through the turbinated 
bone be rendered unnece.ssar3\ lyeave all wounds entirely 
open and irrigate dail}' with antiseptic solutions. 

Dangers. Care must be exercised to not injure the 
superior maxillary division of the trifacial nerve, NF, Plates 
V and VI, either in trephining or after the sinuses have 
been opened. The bony conduit of this nerve is in rare 
cases entirely resorbed by pressure from dental cysts or other 
causes, leaving the nerve stretched across the cavit}' as a 
white nacrous cord, intensely sensitive. Any injur}^ to this 
nerve causes intense pain and renders the animal very re- 
sistant to the necessary manipulations in the after care of 
the wound and may leave it permanently nervous about the 
handling of its face. 

Hemorrhage is generally not severe and may occur from 
the skin, where it should be controlled by compression or 
ligation ; from the inter-osseous vessels, where it may be 
controlled by pressure with absorbent cotton, by pushing a 
small portion of the cotton into the channel of the vessel 
with a needle or tenaculum or by plugging the vessel with a 
conical piece of wood ; from the wounded turbinated bones 
where it may be controlled by packing with cheese cloth. 
These tampons should be removed after twenty-four hours. 



36 TREPHINING THE NASAL FOSSAE. 



5. TREPHINING THE NASAL FOSSAE. 

Uses. Operations on the septum nasii, upon the tur- 
binated bones, tlie removal of tumors or foreign bodies. 

Instruments. Same as for the frontal sinuses. 

Technic. The trephining is carried out by the method 
described abov^e, in the region of the nasal bone, close by 
the median line of the face and according to indications at 
any point from a level of the dotted line SM, Plate IV, to 
the upper extremit}' of the false nostril. The operation 
should be immediately against the median line since other- 
wise the frontal or superior turbinated sinuses may be 
opened, the highly vascular superior turbinated bone 
wounded or an important inter-osseous artery in the nasal 
bone just above its union with the superior turbinated bone, 
as shown in Plate VI, may be severed. Special care is also 
necessary that the trephining should not be carried too 
deeply and that the disc of bone be carefully removed in 
order to avoid wounding the highly vascular turbinated 
bone which lies in close proximity to the nasal bone. The 
operative area is narrow and the trephine used should not 
exceed 2 cm. in diameter. Whenever possible the opera- 
tion should be carried out on the standing animal which de- 
creases the hemorrhage and the danger from aspiration of 
fluids. Even in the standing animal, if extensive operations 
are to be carried out on the very vascular septum nasii or 
on the turbine it is generally advisable to perfom trache- 
otomy before trephining, and retain the trachea tube in 
position until all danger has passed. When the animal is 
confined in the recumbent position the patient's safety de- 
mands that tracheotomy be performed before the operation 
is begun in almost all cases. Anaesthesia ma^^ be maintained 
in such cases b}" means of an ordinary funnel with its spout 
bent at rio-ht angles and inserted into the trachea tube while 



POLL EJVL OPERATLON. 37 

the chloroform is dropped on a towel spread over the mouth 
of the funnel. x\fter completing an\' required operation on 
the septum, turbinated bones or other parts, hemorrhage 
ma}^ be controlled b}' plugging one or both nasal fossa with 
single strips of gauze of sufficient size and carefull}^ se- 
curing them bv sutures to the sides of the trephine wound 
or otherwise. 



6. POLL EVIL OPERATION. 
Plate VII. 

Instruments. Clipping shears, razor, sharp scalpels, 
probe-pointed bistoury, probe, Luer's bone forceps, bone 
gouge, curette, suture and dressing material. 

Technic. Confine the animal in lateral decubitis prefer- 
ably upon the operating table, place under complete anaes- 
thesia and remove the halter or other headgear. Clip the 
foretop and mane and shave the forehead and the top of the 
neck ba^k to a distance of 8 or 10 cm. and behind the sup- 
posed extension of disease, and disinfect the area. With a 
sharp scalpel make a longitudinal incision on the median line 
of the head and neck beginning at a point presumably posteri- 
or to the diseased area and carrying it over the poll down onto 
the forehead for a distance of 4 or 5 cm. below the foretop. 
Continue this incision through the skin, the subcutem, the 
adipose tissue, AT, Plate VII, and either through or passing 
around alongside the neck ligament, LN, into the diseased 
area beneath the latter. Di.ssect the ligamentum nuchae 
away from the adjoining tissues as far back as diseased and 
divide obliquely upward and backward as indicated at AA, 
Plate VII and detach anteriorly from the base of the occiput. 
Be careful to remove every portion of the ligament in the 
area indicated and remove all calcareous deposits or diseased 
tissues. With lyUer's forceps groove a channel about 2 cm. 
wide from behind to before through the occipital protuber- 



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LIGATION OF THE PAROTID DUCT. 41 

ance to the depth of about 2 cm. making the bottom of the 
groove as near as possible on a level with the bottom of the 
wound in the soft tissues as indicated by the dotted line, A A, 
Plate VII. Using Luer's forceps as a curette detach all 
vestiges of the neck ligament from the base of the occiput 
and leave the bone bare and smooth. Be careful to avoid 
penetrating the cranial cavity or the occipito-atloid articula- 
tion. Control the hemorrhage, cleanse and disinfect the 
wound, pack with iodoform gauze and sutuie for its entire 
length except the anterior part where the packing should 
slightly protrude and dust the margin of the wound over 
with iodoform and tannin. Remove the pack after forty- 
eight hours and dress antiseptically daily. The sutures may 
or may not be removed according to conditions. In carrying 
out this operation our chief aim should be to remove all 
diseased parts, to afford perfect drainage anteriorly, to secure 
and maintain asepsis, and to keep the wound directl}^ on 
the median line from which no visible scar will result. 



7. LIGATION OF THE PAROTID DUCT. 
Plate VIII. 

Objects, The destruction of the parotid gland in case of 
fistula from wounds or abscesses. 

Instruments. Razor, convex scalpel, straight probe- 
pointed scalpel, tenaculum forceps, ligation forceps, tenacula, 
needle holder, probe, suture and dressing material. 

Technic. In case of salivary fistula insert a probe 
through the fistula into the duct toward the gland and with 
a sharp scalpel lay the parotid duct free for a distance of 
from I to 2 cm. on the glandular side of the fistulous open- 
ing. If the fistula has its location on the side of the cheek, 
cast the horse and shave and disinfect the region on the 
inferior maxilla where the artery, vein and parotid duct 
turn around its inferior border. When the operator glides 
his finger over the vascular region from before backward 



Pi. ATE VIII. 
Ligation of the Parotid Duct. 

Fig I. Segment of the left ramus of the in- 
ferior maxilla of the horse seen from the right 
and beneath, sp, usual operative field ; a, ex- 
ternal maxillary artery ; v, external maxillary 
vein ; st, st, parotid duct. 

Fig. 2. Life size of operation field at sp, fig. i ; 
a, external maxillary artery ; v, external maxil- 
lary vein ; st, parotid duct ; in, uias.'-eter muscle. 



-^-^■W'r— T<. 




Fig I. 




Fig 2 



LIGATION OF THE PAROTID DUCT. 45 

there is felt a resistant cord, the external maxillar^^ arter}^ 
about 3 mm. in diameter, pulsating in the living animal. 
Between this and the oral border of the masseter muscle make 
an incision about 4 cm. long parallel with the artery through 
the skin and skin muscle. This incision is more readil}^ 
made by gathering up a fold of skin about 2 cm. high and 
cutting through this. Pick up the loose connective tissue 
with a pair of forceps and excise it. Immediately behind 
the external maxillary artery, a. Figs. I and II, Plate VIII, 
is the external maxillary vein v and behind this and immedi- 
ately on the border of the masseter muscle lies the parotid 
duct, st. In case of salivary calculi which cannot be re- 
moved through the mouth and cystic dilation of the par- 
otid duct, make the cutaneous incision at the affected 
point, open the parotid duct, and after the removal of the 
calculus, etc., close the duct wound by means of intestinal 
sutures in such a way that the external surfaces of the lips 
of the wound in the wall of the duct are brought in contact, 
or ligate the duct on the proximal side of the point of opera- 
tion. Ligation is accomplished by passing a strong silk 
thread behind the duct 1)}' mear.s of a curved needle carry- 
ing it around the duct and tying with a surgeon's knot. 
The parotid duct can also be previously split and an internal 
wound made at the point of ligation. Close the skin wound 
by means of a continuous suture and cover the operative 
surface with iodoform collodion or with wound gelatine. 



46 



ENTROPIUM OPERATION. 



8. ENTROPIUM OPERATION. 



Instruments. Razor, convex scalpel, tenaculum and 
ligation forceps, tenacula, needle holder, needles, thread, 
absorbent cotton. 

Technic. Quiet adult horses may be operated upon in 
the standing position with the aid of local anaesthesia, other 
horses and small animals should be secured in lateral re- 
cumbenc}^ preferably upon the operating table. Shave and 
disinfect the skin of the inverted eyelid. Grasp the skin of 
the eyelid midway between the inner and outer canthi 
either with the fingers or the forceps and elevate a skin fold 
parallel with the border of the eyelid to such a height that 
the inverted member assumes its normal position. Pass 




Fig I. 
Entropivim operation on the snperior and inferior eyelids of the dog. 

one finger into the conjunctival sac to make sure that the 
conjunctiva is not drawn into the skin fold. Clip the fold 
off with the scissors immediately below the forceps, remov- 
ing an oblong piece. Between the border of the eyelid and 
the border of the wound the skin should be left intact for at 
least .5 cm. Ligate any bleeding vessels and close the 
wound by means of interrupted sutures. The wound 
may be covered with iodoform collodion or wound gelatine 
or dusted over with iodoform-tannin. It is usually un- 
necessary and inadvisable to cover the parts with hood or 
other appliance since so long as the wound is healing 
properly the animal will not disturb it. 



STAPHYLOTOMY. 47 



9. STAPHYLOTOMY. 

Object. An operation devised by Dr. M. H. McKillip 
for making a manual exploration of the Eustachian tubes, 
guttural pouches, phirynx and posterior nares ; and for 
operations upon these structures. The form and extent of 
the soft palate of the horse is such as to render it extremely 
difficult to make a manual exploration of the parts above 
and behind it, and impossible to make a visual examina- 
tion except with the aid of the expensive and complicated 
rhino-laryngoscope, which only aids in diagnosis while 
staphylotomy combines with this operative advantages, per- 
mitting the free introduction of the hand into the laryngo- 
pharyngeal region. 

Instruments. Mouth speculum, short curved probe 
pointed bistoury with a ring to fit the middle finger. 

Technic. Cast the patient or secure on the operating 
table in lateral recumbency and turn the nose upward. 
Adjust the mouth speculum and open the mouth as wide as 
possible ; draw the tongue well out with the left hand while 
the right carrying the knife on the middle finger is passed 
carefull}' through the fauces until it hooks over the posterior 
border of the soft palate. The knife is then gently drawn 
forward making an incision along the median line of the 
.soft palate from its posterior, free border to its attachment 
on the palatine bone. The hand is then withdrawn and the 
speculum removed for a few minutes to permit the patient to 
rid its pharynx of any blood clots or mucus that may have 
accumulated. Readjusting the speculum as before, the 
right hand is again passed through the fauces and now that 
the palate is divided a digital exploration will perfectly re- 
veal the presence of any abnormality in the region. 



48 TRIFACIAL NEUROTOMY. 

lo. TRIFACIAL NEUROTOMY. 
Plate IX. 

Object. The relief of involuntary shaking of the head. 

Instruments. Razor, scissors, convex scalpel, teiiacula, 
aneurism needle, compression artery forceps, needles, thread, 
absorbent cotton, a strong piece of muslin 12 cm. square. 

Technic. Secure in lateral recumbency, preferabl}' upon 
the operating table, and produce complete anaesthesia. Re- 
move the halter, bridle, or other head gear. Shave and dis- 
infect an area 8 to 10 cm. square over the infra-orbital fora- 
men. Locate by touch the infra-orbital foramen, lOF, Plate 
IX, below the levator labii superioris proprius muscle and 
displace the latter, LL, downwards toward the inferior maxilla 
until the foramen can be felt above the muscle. By pushing 
this muscle downward the branches of the glosso-facial 
vessels which lie chiefly below it are pushed downward with 
the muscle so that the incision can be made without wound- 
ing them. Begin the incision i cm. above the foramen and 
carry it down directly over the middle of the nerve a distance 
of 5 or 6 cm., through the skin, subcutem and the levator 
labii superioris alaque nasii muscle, laying bare the nerve 
NF, where it emerges from the foramen. Let an assistant 
hold the lips of the wound apart and the levator muscle 
downwards with two tenacula, dissect away the connective 
ti.ssue surrounding tiie nerve until the latter is clearly de- 
fined, pass the aneurism needle beneath the nerve from 
above downwards being especially careful to include the 
uppermost or dorsal twigs, and passing a curved probe- 
pointed scalpel or the blade of a pair of scissors underneath 
it, divide the nerve at the foramen, grasp the distal end with 
forceps and excise a piece at least 3 cm. long being careful 
to include all branches. Control the hemorrhage ver}^ care- 
fully. Cleanse the wound, sprinkle with iodoform and close 



TRIFACIAL NEUROTOMY. 49 

with continuous sutures. Place the square piece of muslin 
centrally over the wound and fix it securely to the skin by 
means of strong sutures at each corner, in order to protect it 
while the other nerve is being cut. Turn the animal to the 
opposite side and repeat the operation on the other nerve 
except the application of the square piece of muslin which 
is here unnecessar}'. As soon as the animal stands, remove 
the protective piece of muslin from the first wound, disinfect 
both wounds, dust them over with iodoform and tannin or 
cover with wound gelatine and leave undisturbed to heal b}' 
primary union. Avoid halter, bridle or other fixtures which 
might injure the wounds after the operation. 

Dangers. The chief danger in the operation is from in- 
fection, which sets up a severe neuritis in the proximal end 
of the nerve, aggravates the symptoms and causes much 
suffering. In order to prevent infection the aseptic precau- 
tions need be unusually strict in every detail and the anaes- 
thesia profound. Carefully avoid wounding the neighbor- 
ing vessels and control completely any hemorrhage that 
occurs in order to avoid a hematome in the wound, which 
would invite infection. 

Literature. Involuntary twitching of the head relieved 
by trifacial neurectomy. W. L. Williams, Jour. Comp. 
Med. and V. A., vol. XVIII, p. 426. Involuntary shaking 
of the head and its treatment by trifacial neurectom3^ do. 
Am. Vet. Rev., vol. XXIII, p. 321 and CEst. Monatsch. 
Thierheilkunde, Bd. XXIV, s. 211. 



PivATE IX. 

Trifaciai, Neurotomy. 

LL, Levator labii superioris proprii displaced 
ventralwards toward inferior maxilla. It origin- 
ally rested at end of dotted line from lOF ; lOF, 
infra-orbital foramen ; NF, superior maxillary 
division of the trifacial nerve. 



OPENING OF THE GUTTURAL POUCHES. 53 

II. OPERATIONS ON THE NECK. 

II. OPENING OF THE GUTTURAL POUCHES. 

Pirate X. 

Instruments. Razor, scissors, coiiv^ex pointed and 
straight probe pointed scalpels, artery forceps, tenacula 
probe, trocar, curette, drainage tubing, suture and dressing 
material. 

Technic. I. Viborg' s method. The operation is possible 
on the standing animal, but generall}^ the patient must be 
cast or placed on the operating table and secured in lateral 
decubitis with the head extended. By extending the head 
and compressing the jugular vein there is brought out the 
triangle immediately behind the posterior border of the in- 
ferior maxilla and below the parotid gland comprised be- 
tween the posterior angle of the inferior maxilla, the terminal 
tendon of the sterno-maxillaris muscle and the external 
maxillar}' vein. In this so-called Viborg's triangle after the 
removal of the hair and the disinfection of the skin which 
is maintained stretched, make a 5 cm. long incision through 
the skin and skin muscle immediately beneath the afore- 
mentioned tendon and parallel to it. In case of pronounced 
swelling in Viborg's triangle the operator must determine 
the location for the incision by the position of the sterno- 
maxillaris muscle. The skin and subcutem having been 
incised to a sufficient extent, force a passage with the finger 
or with probe pointed scissors closed or other blunt instru- 
ment through the loose connective tissue on the median side 
of the parotid gland, which area is free from large vessels 
and nerves, to the guttural pouch and penetrate it at its 
lowest point with the finger or trocar. In order to open 
the empty guttural pouch it is desirable to grasp a portion 
of its wall by means of forceps. Through the operative 



Pirate X. 

Opening of the Gutturat^ Pouches (Hyo- 

vertebrotomy) According to Viborg 

AND Chabert. 

Head and neck of recumbent horse viewed 
from the side, sni, Stylo maxillaris muscle ; />, 
parotid gland ; /, guttural pouch ; k, larynx ; 
st, sterno-maxillaris muscle ; ?', rectus capitus 
anticus major muscle ; c, external carotid artery ; 
e^ external maxillary artery ; /, internal maxil- 
lary artery ; v, external maxillary vein ; s, 
probe ; a, wing of atlas. 



OPENING OF THE GUTTURAL POUCHES. SI 

wound a drainage tube can be introduced into the pouch, 
and fixed in its position by sutures. The opening can be 
enlarged in an anter-posterior direction to the extent of 5 to 
8 cm. 

A far more common operation in veterinary practice 
than the opening of the guttural pouches, is the opening of 
abscesses of the sub-parotid lymph glands, lying between the 
inner face of the parotid and the external face of the guttural 
pouch. The operation here used is the same as Viborg's 
for the guttural pouch but does not penetrate that cavity 
because the inner wall of the abscess has pushed the ex- 
ternal wall of the pouch inward so that the former largely 
occupies the usual location of the guttural pouch. The 
dyspnoea generally prohibits casting the animal and neces- 
sitates operating in the standing position. In some cases 
the d3'Spnoea is so severe as to demand tracheotomy before 
the opening of the abscess can be undertaken because the ex- 
citement aggravates the difficult respiration to the point of 
suffocation. 

II. ChaberV s method. Secure the horse in the lateral re- 
cumbent position, remove the hair and disinfect the skin 
beneath the wing of the atlas. Make an incision about i 
cm. in front of the lower half of the wing of the atlas and 
parallel to it, about 6 cm. long extending through the skin 
and skin muscle down to the parotid gland. The incision 
is facilitated by rendering the skin tense with the left hand 
and care is to be taken not to wound the auricular nerve 
which passes directly along the atlas. Tlien draw backward 
the posterior lip of the wound and separate with blunt in- 
struments the posterior border of the parotid gland from the 
atlas, to which it is bound by loose connective tissue, and 
draw the gland forward with tenacula. At the bot- 
tom of the opening thus formed there is seen the stylo- 
maxillaris muscle, sin, Plate X, lying against the median 
side of the parotid gland covered only b}' the aponeurosis of 
the mastoido-humeralis muscle. With the handle of the 



58 OPENING OF THE GUTTURAL POUCHES. 

scalpel inclined toward the wing of the atlas penetrate in the 
direction of their fibers the aponeurotic expansion of the 
mastoido-hnmeralis ninscle and the sterno niaxillaris muscle. 
The puncture is thus located between the ninth and tenth 
nerves on one side and the internal carotid on the other. 
Since the wall of the guttural pouch rests against the median 
side of the digastricus muscle it is opened by this incision. 
The operator inserts an index finger along the blade of the 
knife at first and then withdrawing the instrument passes 
the other index finger also in the penetrant wound and by 
forcibl}' parting these dilates it. The abnormal contents are 
then removed by means of forceps, curetting and irrigation. 
In order to prevent adhesion of the wound lips in the firmh' 
stretched stylo-maxillaris muscle, introduce a strong drain- 
age tube into the pouch and fix it to the external borders of 
the wound by a suture. 

III. Dieterich' s method. This combines the operations 
under I and II, with the difference that the superior opening 
of the pouch is made immediately behind the stylo-maxillaris. 
In order to accomplish this the cutaneous wound over the 
wing of the atlas must be prolonged below it. After detach- 
ing the posterior border of the parotid gland the operator 
searches in the loose areolar tissue with the index finger of 
the left hand for the vascular angle which is formed b}' the 
occipital, internal carotid and external carotid arteries which 
may be detected by pulsation — the same is located at a depth 
of somewhere from 8 to lo cm. Place the volar surface of 
the finger in the vascular angle and push a sharp scalpel 
along the dorsal surface of the finger to the pouch which 
here becomes opened on its posterior lateral surface. 

This method has the advantage over Chabert's that for 
the removal of hard contents (chondroid) the opening can 
be readily dilated, even to such an extent that the entire 
hand can be passed into the air sac and the opening of the 
Eustachian tube be explored. 



TRACHEOTOMY. 



59 



12. TRACHEOTOMY. 
Fig. 2. 

Instruments. Razor, scissors, convex scalpel, tenacula, 
tenacLilum and ligation forceps, trachea tube, and suture ma- 
terial. 

Technic. In the superior third of the neck, in the region 
of the fourth to the sixth tracheal ring, shave and disinfect 
the skin on the anterior surface of the neck to the extent of 
ID cm. long b,v 5 cm. wide. The operation is best performed 
upon the standing animal with the head extended In lat- 
eral decubitis of the horse the operation is carried out with 
.some difficulty, and generally the operator fails to get the 
incision on the median line. The operator stands before the 




Fig. 2. 

Tracheotomy. 5, sterno-thyro-hyoideus muscle ; /, trachea ; 
sch, mucous membrane of the posterior wall of the trachea ; 
/, interannular ligament. 

right shoulder of the horse and the assistant opposite him. 
On the shaved area the operator and his assistant takes up a 
transverse fold of skin 3 to 4 cm. high, and divides the same 
by an incision. The 6 to 8 cm. long wound in the skin then 



6o TRACHEOTOMY. 

lies in the median line of the anterior face of the neck. Or 
the incision ma}- be made by rendering the skin tense along 
the median line of the trachea with the left hand, then mak- 
ing a drawing cut from above to below with the scalpel. 
After the skin muscle is cut through, in order to avoid hem- 
orrhage, separate the two sterno-thyro-hyoideus muscles by 
means of tenacula along the median line in the white strip of 
connective tissue. The opening into the trachea may be 
made in a variety of ways. The quickest and most crude 
method is to slit the trachea which has been laid bare from 
above downwards through three or four tracheal rings, and 
pressing the severed ends apart insert the tube through the 
opening. Since the tracheal rings are incomplete, being 
open on their dorsal surfaces, cutting through the ventral 
portion divides each ring into two separate parts and their 
being pushed apart, distorts them and tends to the causation 
of chondritis and collapse of the trachea, a danger which in- 
creases with the duration of time that the tube is maintained 
in position. It is therefore most suitable for hurried opera- 
tion in impending suffocation where the tube will probably 
be needed for a short time only, 

A second method of operation, illustrated in Fig. 2, con- 
sists in making a transverse incision through the inter-annu- 
lar ligament between the two last exposed tracheal rings the 
length of the diameter of the tube to be inserted. Make 
a perpendicular incision upward from each end of this at a 
point I to 1.5 cm. from the median line through one or two 
tracheal rings, according to the size of the tube. With 
forceps or tenaculum grasp the segments of partially de- 
tached cartilage and remove them by cutting through the 
inter-annular ligament. 

A third and to us preferable method is to insert a scalpel 
transversely at about the lower third of the lowermost bared 
tracheal ring and cutting outwards and upwards in a curved 
line, pass through the first inter-annular ligament and con- 
tinue the incision into the succeeding tracheal ring, curving 



ARYTENECTOMY. 6i 

the incision upward and inward until the ring is cut about 
Yi in two, when the incision is turned downward to eventu- 
ally reach the starting point, the isolated section of the tra- 
chea being securely grasped by a pair of forceps before its 
excision is completed. By this method no tracheal ring is 
severed. 

The trachea tube is to be removed and cleansed daily as 
long as its use is necessary, and when finalh^ removed the 
wound .should be left open and dressed antiseptically. 



13. ARYTENECTOMY. 

Pi. ATE XI. 

Object. The relief of roaring or laryngismus paralyticus. 

Instruments. Razor, scissors, scalpel, razor shaped 
knife with long handle, long curved sharp pointed scissors, 
long curved uterine dressing forceps, double tenaculum for- 
ceps, trachea tube, retractors, reflecting lamp, absorbent cot- 
ton and dressing material. 

Technic. Secure the animal in lateral recumbency 
preferably upon the operating table and induce complete 
anaesthesia. Shave and disinfect the skin over the laryngeal 
region and also over the trachea at the usual point for 
tracheotomy. Place the animal upon its back with the head 
extended and remove the halter or other head gear. Per- 
form tracheotomy in the manner described above, insert the 
trachea tube and if necessary continue the administration of 
chloroform through this by means of a funnel the small 
end of which is inserted in the trachea tube while the 
chloroform is dropped on a towel spread over the larger end. 
The operator takes his place on the right side of the animal 
and the assistant on the left. Make a longitudinal incision 
through the skin and subcutem beginning at the anterior 
part of the thyroid cartilage and extending backward on the 
median line to the 3rd or 4th tracheal ring. Control the 
cutaneous hemorrhage. Continue the incision through the 



Plate XI. 
Arytenectomy 



E, epiglottis ; TT, thyroid cartilage ; CC, 
cricoid cartilage ; TRI, first tracheal ring ; V, 
left vocal cord ; A, left arytenoid cartilage sur- 
rounded by dotted line of incision ; CTL, crico- 
thy-ro'idean ligament. 






V 



rl^^-^%. 




A R YTENECTOM Y. 65 

subjacent muscular tissue being careful to follow the median 
line exactly until the crico-thyroidean ligament, CTL, Plate 
XI, the cricoid cartilage C, and the first tracheal ring TRI, 
are laid bare. Again control any hemorrhage. Plunge the 
scalpel with its cutting edge directed backward through the 
crico-thyroidean ligament on a level with the dotted line T 
and extend this backward along the median line severing the 
cricoid cartilage, C, and the first tracheal ring, TRI. Insert 
the retractors and have the larynx held well open by as- 
sistants. Illuminate the larynx by means of a reflecting 
lamp as ma}' be required. x\fter controlling any hemorrhage 
caused by the foregoing make an incision through the mucosa 
and the intervening connective tissue between the two 
arytenoid cartilages, A, beginning at the anterior part and 
extending backward to the cricoid, thence turning upward 
and laterally, incise the mucosa across the posterior end of the 
arytenoid thence forward along its lateral border through 
the vocal cord, V, and turning downward as the animal lies, 
that is toward the dorsal part of the larynx, continue the 
incision to the point of beginning. In making this incision 
cut as closely as possible to the margin of the cartilage so 
that a minimum amount of the mucous membrane will be 
removed. Grasp the lateral border of the cartilage with 
the long tenaculum forceps and with the razor-shaped knife 
or the scissors .separate the lateral and anterior portions of 
it from the adjacent tissues keeping always immediateh' 
against it in order to produce as clean a wound as possible 
and to avoid injuring adjacent vessels from which hemor- 
rhage would occur. 

When the cartilage has been detached over the greater part 
of its surface locate the crico-arytenoid articulation and dis- 
articulate or cut through the arytenoid as close to the articu- 
lation as possible with the razor-shaped knife or the scissors. 
Remove all blood by means of pledgets of absorbent cotton 
securely held in the long dressing forceps, or the clots may 

5 



66 INTRA-TRACHEAL IRRIGATION. 

be pushed into the phar3nix when they will generally be 
swallowed. Carefully remove any cartilaginous remnants 
or tissue shreds and control the hemorrhage from any 
visible vessels. Dust the wounds thoroughly with iodoform 
and tannin and if the capillary hemorrhage is great pack 
the larynx with a single strip of iodoform gauze and secure 
it by sutures through the margin of the skin wound. Re- 
move this tampon after twelve to twenty-four hours. Wash 
and disinfect the laryngeal wounds daily. Remove and 
cleanse the trachea tube and wash the tracheal wound dail}^ 
and keep the trachea tube in position for five to seven days 
according to conditions. After about eight days the re- 
tractors should be placed in the laryngeal wound, the wound 
dilated and the interior of the larynx examined with the 
aid of a reflecting lamp and any unhealthy granulations or 
other untoward conditions given proper attention. 



14. INTRA-TRACHEAL IRRIGATION. 

Objects. The washing of irritant or septic substances 
from, and the disinfection of, the trachea and bronchi. 

Instruments. Same as for tracheotomy, and a gravity 
irrigating apparatus fitted with 3 m. of rubber tubing about 
I cm. in diameter, 5 liters of .6 percent, soda bicarbonate or 
chloride solution at a temperature of 37 to 39° C. 

Technic. Operate on the standing animal. Perform 
tracheotomy. Elevate the gravity apparatus containing the 
irrigating fluid i to 2 m. above the patient, have the animal's 
head slightly elevated, insert the free end of the rubber 
tubing in the trachea tube and let the fluid flow into the 
trachea in a moderate stream until it is filled and the animal 
makes expulsive efforts, when the inflow is stopped and the 
animal permitted to lower his head and expel the fluid, then 
raise the head again and repeat until the fluid is expelled 
clear. Repeat the operation according to requirement. In 
cases of suppurative bronchitis, peroxide of hydrogen may 
be added to the solution. 



INTRA VENOUS INJECTION. 



67 



15. INTRAVENOUS INJECTION. 
Fig. 3. 

Instruments. Scissors, In'podermic syringe. 

Technic. The operation is performed on the standing 
animal on either jugular vein at about tlie juncture of the 
upper and middle thirds of the neck ; to most operators the 
right jugular is the more convenient. x\t the place desig- 
nated the subscapulo-hyoideus muscle lies between the 
jugular vein and the carotid artery. After clipping the hair, 
the skin should be carefully disinfected. The vein lies in 




Fig. 



■•'»' 

Intravenous Injection. 



the jugular groove between the mastoido-humeralis and the 
sterno-maxillaris muscles covered only by the skin and skin 
muscle. Stand by the shoulder of the horse and compress 
the jugular with the thumb as shown in Figure 3 or with the 
second to the fourth fingers, in which case the ball of the 
thumb rests on the mastoido-humeralis muscle, in a way that 
the vein becomes filled above the point of compression in the 



68 INTRAVENOUS INJECTION. 

shorn area and stands out as a swollen cord. In the case of 
fleshy necked horses this compression is more readil}^ attained 
if the head is somewhat elevated and extended b}' an 
assistant. If the vein can not be made prominent in this 
way the compression should be alternately applied and, with- 
drawn suddenly, the course of the vein then reveals itself by 
a wave-like movement along the jugular groove. Just above 
the point of compression the vein is the most fully distended 
and firmly fixed. After testing the hypodermic needle to 
see that it is open hold it between the second and third 
fingers while the thumb covers its posterior opening and 
thrust it through the skin, cutaneous muscle and jugular 
wall, in the direction of the vein obliquely forwards and up- 
wards 1 to 2 cm. deep, so that the point of the needle enters 
the vessel at its most distended part. In this way it is easy 
to prevent injur}^ to the median wall of the vein. If the 
vein has been properly punctured blood will flow from the 
needle upon the removal of the thumb. If the vein is not 
entered at the first attempt the needle should be partly with- 
drawn and then pushed in again in a slightl}^ different direc- 
tion. The compression is then removed and the hypodermic 
syringe in which no air is contained is connected and the 
contents slowly discharged into the vein. In withdrawing 
the needle be careful to press the skin firmly against the 
underlying part. The omission of this precaution frequently 
results in the formation of a subcutaneous hematome. 



PHLEBOTOMY. 69 

16. PHLEBOTOMY. 
Fig. 3. 

Instruments. Razor or scissors, fleams, lancet, phle- 
botomy trocar, spring lancet, pins, suture material. 

Technic. a. PJdebotomy with fleams may be performed 
on either jugular vein. The operation is preferably carried 
out on the standing animal, but is not difficult when the 
patient is recumbent. The point of operation is at about the 
boundary line between the upper and middle cervical regions, 
because it is here that the subscapulo-hj-oideus muscle which 
separates the jugular vein from tiie carotid artery is mo.st 
voluminous and consequently affords the greatest protection 
to the latter. At this point clip or shave and disinfect the 
skin. Grasp the extended blade of tlie fleam at the joint 
with the thumb and index finger of one hand, while the 
third and fourth fingers compress the jugular vein at a point 
far enough below the shaved part that the fleam blade rests 
upon it. In fleshy-necked animals the course of the vein 
may be clearly made out by causing its repeated distension 
and relaxation. It is well to be careful that the point of the 
fleam blade is not allowed to prick the skin prematurely and 
render the animal re.-btless, and that the fleam blade is held 
perpendicular to the surface and parallel to the long axis of 
the vein. The most elevated point of the vein should be 
struck by the blade in such a way that the skin, subcutane- 
ous muscle and jugular wall are penetrated parallel to the 
long axis of the vessel. Drive the fleam blade into the vein 
by a short, sharp blow with a light wooden stick. The ex- 
tension on the fleam blade prevents its being driven too 
deeply. The size of the blade to be used depends upon the 
thickness of the skin and other tissues covering the vein. If 
the vein is opened, dark red blood escapes from the wound 
in a large stream. If the operation does not succeed at the 



70 PHLEBOTOMY. 

first effort, one should select an undamaged portion of the 
skin for a second attempt so that the opening into the vein 
may be direct and clean. When the vein is opened lay the 
instrument aside, the compression of the vein being contin- 
ued in order to prevent aspiration of air into it and also that 
the lips of the wound shall not become overlapped by which 
the escape of blood would be impeded or stopped. The flow 
of blood may be favored by inducing masticatory movements 
by the animal. The amount of blood withdrawn varies be- 
tween 3 and 8 liters, according to the size of the animal and 
the object to be attained. The wound may be closed by an 
interrupted or a pinned suture. For the latter, relieve the 
compression on the vein and grasp the lips of the skin woinid 
between the finger and thumb and stick the pin perpendicu- 
larly through the middle of it a few mm. from its borders. 
Apply a noose of silk ligature previously prepared over the 
pin and close and tie the loop. In applying the pin and 
loop, take care not to elevate the skin from the underlying 
part, which tends to the production of a hematome. 

b. With the lancet the operation is preferably performed 
on the right side of the neck. Compress the vein as illus- 
trated in Fig. 3, and hold the lancet between the thumb and 
index finger with the blade at right angles to the handle, 
the thumb and finger being so placed on the blade that it 
can barely penetrate the vein, and then push it in cjuickly 
just in front of the compressing thumb through the skin, 
subcutem and venous wall as deep as the fingers holding the 
lancet will permit. 

Hold the blade perpendicular to the long axis of the 
vein, and avoid directing the point dorsalwards, which would 
endanger the superior wall of the vessel or cause the 
lancet to glide over the wall and not enter the vein. When 
the lancet has entered the vein extend the wound somewhat 
toward the head by flexing the hand dorsally. In cattle it 
is necessary to compress the vein by means of a cord tightly 



LIGATION OF THE CAROTID ARTERY. 71 

drawn around the neck, the operator taking the same posi- 
tion as in the horse while an assistant holds the animal by 
the horns or nose. Close the wound as in a. 

Phlebotoni}^ with the spring lancet is carried out in a sim- 
ilar manner, the jugular being compressed in the same way, 
and the lancet with the spring set placed over the vein in 
such a way that the opening w^iil be made in the same direc- 
tion and manner as with the fleams. The lancet blade is 
then released and penetrates the vein. The compression be- 
low is continued as in other cases. 

c. Phlebotomy with the trocar is performed in the same 
manner as has been described for intravenous injection. So 
long as the flow of blood continues the compression of the 
vein must not be intermitted. The phlebotomy trocar should 
be about 5 mm. in diameter. 



17. LIGATION OF THE CAROTID ARTERY. 
Plate XII. 

Objects. The control of hemorrhage from wounds or 
the prevention of hemorrhage during the removal of tumors 
or other operations in the parotid region. 

Instruments. Scissors, scalpel, tenacula, aneurism 
needle, mouse-toothed forceps, ligation forceps, suture 
material. 

Technic. The operation is possible on the standing 
animal with the aid of cocaine or other local anaesthetic but 
it is preferable to confine the patient in lateral recumbency 
and anaesthetize. 

The operation is made at the same point as for phlebotomy 
and the same cutaneous wound, a, Plate XII, may be used 
for this purpose. The incision should be at least 10 cm. 
long extending through the skin, fleshy panniculus and 



t5 



■J / 




PT.ATE XII. 

Fig. I.— a, Ligation of the common 
carotid artery ; d, CEsophagotomy. 

Fig. 2. — Ligation of the common 
carotid artery. c, common carotid 
artery ;/, jugular vein ; z^, vagus nerve ; 
s, sympathetic nerve ; r, recurrent 
nerve ; p, cervical panniculous car- 
nosus muscle ; in, sternomaxillaris 
muscle ; st, levator humeri muscle. 

Fig. 3. — CEsophagotomy. c, com- 
mon carotid artery ; j\ jugular vein ; 
c, 0^, cesophagus ; s, sympathetic 
nerve ; t, trachea ; si, mastoido hum- 
eralis (lavator humeri) muscle. 






Fig. 2. 




LIGATION OF THE CAROTID ARTERY. 75 

subscapulo-hyoidens muscles and then force a passage with 
the fingers, with tlie cautions aid of the knife, to the trachea. 
At the region of the neck indicated, the carotid passes along 
the border between the lateral and dorsal surfaces of the 
trachea, accompanied dorsally b3' the vagus and sympathetic 
nerves and ventrally by the recurrent. In Figure 2, Plate XII 
the vagus and sympathetic nerves, v and a, are pushed out 
of their normal position and appear ventrally to the carotid. 
Pass the index finger over and behind the carotid until the 
trachea is reached, and encircling the inner and lower sides 
of the artery, force a way through the surrounding areolar 
tissue and draw the vessel out through the operation wound. 
As a rule the carotid is still surrounded by the lamellar 
fascia, which comes from the deep fascia of the neck in 
which also the three above mentioned nerves are found. 
These nerves must be carefully separated from the carotid 
and must on no account be included in the ligature. Ligate 
the carotid twice with an interval of about 2 cm. between 
the two ligatures and divide the artery midway between the 
two. The second ligature is necessary in order to prevent 
hemorrhage from the distal end through collateral anasto- 
moses and it is essential to sever the artery in order to avoid 
its rupture by the stretching of the undivided carotid dur- 
ing movements of the neck where the nutrition has been cut 
off at the point of ligation. Provide drainage for the wound 
and suture the muscle and skin. 



7 6 CESOPHAGO TOM Y. 

i8. CESOPHAGOTOMY. 
Plate XII. 

Instruments. Razor, scissors, convex scalpel, straight 
probe-pointed bistour}^ tenacula, artery forceps, absorbent 
cotton, suture material. 

Technic. The operation can be carried out on the stand- 
ing or the recumbent animal. At its origin the oesophagus 
lies above the trachea, generally somewhat to the left of the 
median line and gradually deviates farther to the left until 
toward the lower cervical region it lies down along the left 
side of the trachea. 

The operation is performed at any point between the 
pharynx and chest where the lodgment of a foreign body or 
other condition may demand it. When the oesophagus is 
empty the operation is best performed in the lower third of 
the neck at /^ Figure i, Plate XII. 

i\n incision lo cm. long through the skin and skin muscle 
is made on the left side between the anterior border of the 
mastoido-humeralis muscle and the jugular vein. With one 
finger each of the left and right hand divide the loose con- 
nective tissue down to the oesophagus, which lies between 
the left scalenus muscle, trachea and the jugular vein. 
Along the supero-external border of the trachea runs the 
carotid, accompanied dorsally by the vagus and sympathetic 
and ventrally by the recurrent nerves. The oesophagus feels 
like a round muscle within which one can feel a firmer cord, 
the mucous membrane, and has a pale red color. CEsopha- 
gus and trachea are surrounded by the deep fascia of the 
neck. Pass one finger around the oesophagus from behind, 
draw it away from the trachea, force a passage through the 
deep fascia of the neck and draw the oesophagus out through 
the external wound. After making an incision through the 
muscle and mucous membrane introduce a probe pointed 



(ESOPHAGOTOMY. 77 

scalpel or a scissors blade into the lumen of the oesophagus 
and split its wall. The mucous membrane is white and lies 
in thick longitudinal folds. When there is a foreign body 
in the oesophagus the operation is performed at the point 
where it is lodged in the manner described and the incision 
should be made only large enough to permit its removal. In 
diverticuli of the oesophagus an elliptical piece of the mucous 
membrane which has been overstretched is cut out. The 
oesophageal wound is closed by a laminated suture, that is, 
the mucous membrane is united by means of an intestinal 
suture and the muscular wall closed over this. The skin 
and muscular wound ma}- either be left open or closed with 
the Bayer suture and bandaged with a drainage tube in the 
lower angle of the wound. 



78 



PUNCTURE OF THE CHEST. 



III. OPERATIONS ON THE TRUNK AND GENITAL 

ORGANS. 



19. PUNCTURE OF THE CHEST. 
Fig. 4. 

Objects. The relief of hydrothorax or pyothorax. 

Instruments. Razor, .scissors, trocar, i 111. of rubber 
tubing of the same size as the trocar, vessel for receiving 
the e.scaping fluid, dressing material. 

Technic. Operate upon the standing animal, the point 
of operation being the seventh intercostal space on the left 
side, and the sixth on the right. Dogs may be laid upon 




Fig. 4. 
Puncture of the chest ; puncture of the intestine. 

the table. The ribs are enumerated from behind forward, 
counting eighteen for the horse and fourteen for the dog. 
Clip or shave the designated intercostal area immediately 
above the thoracic vein. Grasp the trocar firmly with the 



PUNCTURE OF THE INTESTINES. 79 

tluiinb and index finger of one hand at a distance from the 
point which will permit the canula to enter the chest. Af- 
ter the skin over the seat of operation has been drawn aside 
by the hand place the trocar at the anterior border of the 
rib with the point inclined slightly forward and with a sharp 
blow with the palm of the other hand drive the instrument 
through the skin, skin muscle, intercostal muscles, internal 
thoracic fascia and pleura into the pleural sac. When the 
resistance ceases, the thoracic cavit}' has been entered. Re- 
move the stilette and permit the pus, lymph, or other fluid 
to escape. This escape is at first continuous, but later be- 
comes rythmic, synchronous with respiration. The inter- 
mission of the outflow during inspiration permits air to enter 
the pleural cavit}' unless precautions are taken against it ; 
this is most readih' obviated b}' slipping one end of the rub- 
ber tubing over the exposed end of the canula and placing 
the other extremity in the receptacle for the fluid where it 
will be submerged. This will not only prevent aspiration of 
air into the chest but will act as a syphon to aid in the aspi- 
ration of the fluid from the pleural cavity. In the absence 
of the tubing the entrance of air may be avoided by closing 
the canula with the finger after each expiration. 



20 PUN'CTURE OF THE INTESTINES 
Figs. 4, 5. 

Object. The relief of intestinal tympany. 

Instruments. Razor, scissors, trocar, disinfectants. 

Technic. Puncture of the intestine is preferably per- 
formed on the standing horse but may be carried out on the 
recumbent animal. The point of operation is in the right 
flank about equi-distant from the last rib, the extremities of 
the transverse processes of the lumbar vertebrae and the ex- 
ternal angle of the ilium in the standing horse, at the upper- 
most point of the abdomen in the recumbent animal, that is, 



8o 



PUNCTURE OF THE INTESTINES. 



at the most prominent part of the distension. After the 
skin at this place has been clipped or shaved and disinfected 
grasp the trocar with the index finger and the thumb of the 
left hand and holding the instrument perpendicular to the 
skin, give it a firm quick blow with the palm of the right 
hand and drive it through the abdominal walls into the 
intestine. With a properh' constructed trocar of the dimen- 
sions suggested in Figure 5 no preliminar}' puncture with 
the lancet is required or advisable. The cutting end of the 
stilette should be very long, tapering and sharp so that it 
will cut as freel}' as the lancet. B}^ performing the opera- 
tion as directed the trocar ordinarily punctures the caecum. 




Fig. 5. 

Intestine trocar with sheath. Outside diameter of canula 3 mm., 
length of canula, 16 cm. 

Withdraw the stilette and permit the gas to escape through 
the canula. The canula may become occluded by particles 
of ingesta entering it and these should be removed by rein- 
serting the stilette. The intestine first punctured may 
collapse and the flow of gas cease while the tympany con- 
tinues in other parts ; this may be overcome by reintroducing 
the stilette and pushing the trocar through the distal wall of 
the bowel and into the next section of intestine beyond. 
If this does not succeed the trocar may be withdrawn and 
reinserted in a neighboring area or if need be on the opposite 
side of the animal. In withdrawing the canula replace the 
stilette and press the skin against the abdominal with the 
thumb and finger of one hand while the trocar is drawn otit 
with the other. This tends to prevent particles of ingesta 



SUBCUTANEOUS CAUDAL MYOTOMY. 8i 

from following the canula out of the intestine and becoming 
lodged at some point in the track of the wound to set 
up inflammator}' processes there. Before introduction, the 
trocar should always be rendered sterile but should not bear 
irritant antiseptics, which becoming lodged in the wound 
tend to irritate the tissues and produce abcesses. Puncture 
of the intestine is so often extremely urgent that deliberate 
aseptic precautions are not alwaws practicable and trocariza- 
tion only too frequently results in abscesses in the abdominal 
wall. Its prevention must depend chiefly upon the disinfec- 
tion of the skin and instrument. It becomes important to 
use an instrument which is clean in advance. If the one 
shown in fig. 5 is well disinfected after using and the sheath 
is filled with alcohol before it is screwed on, the instrument 
will remain sterile until it is again unsheathed and then the 
alcohol will quickly evaporate and leave it aseptic. 



21. SUBCUTANEOUS CAUDAL MYOTOMY. 
Fig. 6. 

Object. The correction of curved tail. 

Instruments. Sharp straight tenotome, bandage. 

Technic. The point or points of curvature and their 
extent are to be carefully noted b_v having the animal trotted 
away from the operator. The curvature is generally due to 
unequal development of the two levator or extensor muscles 
Fig. 6 e, though quite rarely the depressors, f, ma}^ be 
implicated. Confine the animal in stocks, or in default of 
these, control b^' means of a twitch and sideline. Cleanse 
and disinfect the tail and have it sharplj^ bent by an assist- 
ant in the opposite direction to the curvature. Locate the 
longitudinal furrow between the levator and depressor mus- 
cles on the convex side and at the lower margin of the 
levator and just above v, Fig. 6, insert the tenotome at the 
6 



82 



SUBCUTANEOUS CAUDAL MYOTOMY. 



most prominent part of curvation, the incision being parallel 
with the muscular fibers, and push the instrument entirely 
through the muscle to the vertebra, then turning the cutting 
edge upwards, at the same time advancing the point of the 
tenotome toward the median hue, sever the entire muscle. 
The superior lateral caudal artery, ^, Fig. 6, bleeds profusely 
if severed, and wounding of it may usually be avoided by 
withdrawing the tenotome a trifle in passing that point. 
Wounding the skin over the muscular incision is avoided by 




Fig. 6. 

Transverse section of the tail. ;/, caudal vertebra ; ^, sacro- 
coccygeus lateralis muscle ; e, sacro-coccygeus superior ; f, 
depressor longus and bre vis muscles (sacro-coccygeus infer- 
ior) ; z, intertransversales muscles ; a, coccygeal artery ; s, su- 
pero-lateral coccygeal artery ; /, infero-lateral coccygeal ar- 
tery ; V, caudal veins (dorsal, ventral, lateral) ; sch, caudal 
fascia ; h^ skin. 

placing the thumb of the left hand over the line of incision 
so the knife will be recognized as soon as the muscle and 
caudal fascia are cut through. Remove the knife in the same 
manner as introduced. Release the horse and have him 
trotted again , If the operation is sufficient the tail should curve 
in about the same degree as before, but in the opposite dii^ec- 



CAUDAL MYECTOMY. 83 

Hon. If this has not been attained examine carefully and 
sever any remaining bundles of muscle, and this not sufficing 
repeat the operation as before at another point 5 or 6 cm. 
above or below the first, severing the muscle again. Or if 
the depressor appears implicated, sever it in a similar manner. 
In extreme cases the entire lateral half of muscles, tendons 
and aponeurosis may be severed. Apply an antiseptic pad 
to the wound and retain it by a moderately firm bandage, 
which serves at once as an occlusive dressing and effective 
hemostatic. Remove the bandage after 24 hours. 



22. CAUDAL MYECTOMY. 
Fig. 6 and Pirate XIII. 

Objects. For the prevention of tiie gripping of the reins 
by the tail. 

Instruments. Elastic bandage, elastic ligature, straight 
bistoury, tenacula, absorbent cotton, bandages, disinfecting 
material. 

Technic. Confine the animal in lateral decubitis or in 
stocks, cleanse and disinfect the tail, apply the elastic bandage 
tightly to it beginning at the apex and continuing to its 
base and then apply the elastic ligature as close as possible 
to the root of the tail. Have an assistant hold the tail up- 
wards, i.e., dorsalwards, and tightly stretched. Make an 
incision 15 to 20 cm. long, over the middle of the inferior 
surface of each depressor longus muscle, beginning close 
against the elastic ligature and extending toward the apex, 
severing at once the skin and caudal fascia down to the 
muscle. Let an assistant retract the lips of the incision with 
tenacula while the operator dissects the depressor longus 
muscle, DC, Plate XIII, from the adjacent tissues at either 
side, sever it by a transverse incision close against the liga- 



Pirate XIII. 

Caudai. Myectomy To Prevent Gripping of 
THE Reins. 

DC, Depressor coccygeus longus muscle ; T, 
tourniquet. 



CAUDAL MYECTOMY. 87 

tare and dissect away the entire ninscle down to the lower 
end of the wound and there excise it. The small depressor 
brevis, lying on the median side of tlie longus need not be 
removed, thus preserving a limited depressor power. Re- 
peat the operation on the opposite depressor. Make two 
elongated tampons of absorbent cotton, of the size and form 
of the muscles removed, saturate these in i-iooo sublimate 
solution, insert neatly in the wounds and apply a moderatel}^ 
firm bandage as closely as possible to tlie elastic ligature. 
Remove the ligature, upon which hemorrhage ensues, which 
is to be controlled by the application of a second bandage 
extending higher up on the tail over the previous location 
of the elastic ligature. Remove the bandage in 24 hours, 
wash the parts and saturate the tampons again with i-iooo 
sublimate solution and apply a fresh bandage, allow it to re- 
main for another 24 hours, remove the bandage and tampons 
and treat as an open wound. Care should be taken to not 
apply the bandage too tightly or leave it in place for more 
than 24 hours, since otherwise necrosis of the tail is liable 
to occur and necessitate amputation. 



88 



AMPUTATION OF THE TAIL. 



23. AMPUTATION OF THK TAIL. 
Fig. 6 AND 7. 

Objects. Malignant or incurable diseases of the tail. 

Instruments. Docking shears, ring cautery iron, dock- 
ing chisel, mallet, a block of wood, suture material. 

Technic. I. Docking ivith the shears. Operate on the 
standing animal secured in the stocks or with the aid of the 
twitch and one fore foot held up or the side line applied to 




Fig, 7. 
Amputation of the tail. /, hgatvire for binding the hair of 
the tail upwards. 

a hind foot. The point of amputation is determined by the 
location of the disease. At this point the hair is parted 
around the organ , turned upwards and bandaged to the root of 
the tail with a compression bandage which at the same time 
serves to retain the hair out of the operator's way and to 
make the operation bloodless. Beneath the part clip the 



AMPUTATION OF THE TAIL. 89 

hair away for a space of 3 to 4 cm. around the tail, have an 
assistant hold it horizontally, stand at the side, behind the 
left leg and apply the docking shears in such a wa}' that the 
clipped portion of the dock rests in the semi-circular depres- 
sion in the shears. By quick and powerful closing of the 
handles of the docking shears cut, if possible, between two 
caudal vertebrae at one stroke through the entire organ. 
Grasp the stump of the tail with the left hand and press the 
red-hot ring iron against the parts between the skin and 
vertebrae for from ten to twent}^ seconds in order to stop the 
hemorrhage so that a dry and firm necrotic scab covers the 
wound surface. In cattle and dogs the tail is amputated in 
a similar manner between two vertebrae ; a straight knife 
will answer for operating instrument. Hemorrhage is like- 
wise most promptly controlled by cautery. Ligating the 
arteries and applying a bandage is more aesthetic. 

II. Aniptitation ivith the chisel Prepare for the operation 
in the same manner as in I. Have an assistant hold a block 
of wood against the ventral surface of the tail at the point 
for amputation. Place the chisel on the dorsal surface of 
the tail at the point desired, with its convex side directed 
towards the base of the organ, and with a vigorous blow 
with the mallet drive the chisel through it against the 
wooden block held below. In cases of extensive melanosis 
the chisel may be far too narrow to cut off the entire organ 
at one blow in which case the instrument is still to be placed 
centrally and driven through the caudal vertebrae and the 
lateral parts may then be severed with a scalpel. There is 
now left a triangular wound, the vertebra constituting the 
apex. Ligate any visible vessels and draw the lateral flaps 
together on the median line by means of strong silk sutures 
passed through the two flaps at their thickest parts and 
unite the edges of the wound b}^ frequent interrupted sutures. 
Apply antiseptics and remove the bandage. This operation 
is preferable in point of blemish and sensibility of the stump 
to I. 



go URE THRO TOM Y. LI THO TOM V. 

24. URETHROTOMY. LITHOTOMY. 
Fig. 8, 9. 

Objects. For the removal of calculi from the bladder or 
urethra or perforir.ing other operations on these parts. 

Instruments. Catheter, convex scalpel, scissors, artery 
and compression forceps, tenacula, lithotome, lithotomy 
forceps, lithotrite, absorbent cotton, drainage tube, suture 
material. 

Technic. Urethrotoni}' may be performed on horses in 
a standing position, the hind feet being secured with hobbles. 

It is best, however, to operate under anaesthesia wath the 
patient in lateral or dorsal recumbency, either on the operat- 
ing table or cast, being careful to secure as gently as possible, 
having first emptied the bladder if practicable, since rupture 
of an overdistended viscus may readily occur during violent 
struggles by the animal. 

The point of operation will depend upon the location of 
the calculus or other obstacle. If it is found in the pelvic 
portion of the uiethra or in the bladder, the operation is 
made at the ischial notch. Fig. 8. First the penis is drawn 
out from the prepuce and the catheter introduced into the 
urethra and pushed upward until it has passed the ischial 
notch. After disinfection of the skin, render it tense and 
make a 5 cm. long incision on the median line at the ischial 
arch through the skin, bulbo-cavernosus muscle, spongy 
portion of the urethra, and the urethral mucous membrane 
down to the catheter. Fig. 9, k. In order to prevent infiltra- 
tion of urine after the operation, special care is to be taken 
to make the low^er end of the wound slanting in such a 
manner that the inner margin is higher than the outer. 

After the catheter has been drawn back away from the 
ischial arch, introduce the lithotomy forceps into the urethra 
or bladder, grasp the stone and draw it outward in its natural 
direction. The grasping of the stone by the forceps is 
materially aided by means of the left hand introduced into 



URE THRO rOMY. LIT HO TOM V. 



91 



the rectum. One must avoid grasping, along with the stone, 
the mucous membrane of tlie bladder. Partial filling of the 
bladder with a tepid aseptic solution will aid in grasping the 
calculus and in avoiding the implication of the bladder walls. 
By careful rotary movement and pushing the forceps back- 
w^ard and forward the operator can determine before the ex- 
traction of the stone if the forceps can be withdrawn ea.sil3^ 
and without much resistance through the neck of the 




Fi. 



Urethrotoniv at the ischial notch. 



bladder. If the stone is .so large that it can not pass the 
neck of the bladder lithotripsy must be performed. This 
operation requires time and patience, since as a rule it is not 
possible to encompass the entire calculus with the forceps. 
That is, the narrowness of the neck of the bladder prevents 
the .sufficiently wide opening of the forceps. The stone con- 
.sequently must be gradually broken off at its periphery and 
the individual pieces of calculus removed. The character of 
the surface of the stone has an evident bearing upon the 
practicability of lithotrip.sy. 

When this operation is impossible, the operative dilation 



92 



URE THRO TO MY. LITHO TOMY. 



of the neck of the bladder with the Hthotome can be under- 
taken as a last resort. Introduce the instrument closed into 
the bladder, it is then opened and the neck of the bladder 
divided upward and laterally as the instrument is withdrawn. 
In order to prevent injury to the rectum it should be emptied 
before the operation is undertaken. After the removal of 
the stone, push the catheter again over the ischial arch and 
unite the lips of the wound in the urethral mucous mem- 




FiG. 9. Urethrotomy (life size), /z, skin ; «, retractor penis muscle ; 
b, bulbo-cavernous muscle ; c, spongy urethra ; 11, urethra ; k, 
catheter. 

brane by means of intestinal sutures. Flush the bladder or 
urethra by means of a warm 3 per cent, boric acid solution 
injected through the catheter and then withdraw the latter. 
Finally, suture the skin wound and insert a drainage tube 
or iodoform gauze in the lower angle of the wound. The 
whole wound may be left entirely open and be dressed daily 
with antiseptics. For student practice, on an anaesthetized 
horse, introduce a stone into the bladder through the ure- 
thral wound and practice grasping and removing it with the 
lithotomy forceps. 



AMPUTA TION OF THE PENIS. 93 

25. AMPUTATION OF THE PENIS. 
Plate XIV. 

Instruments. Scalpel, elastic ligature, strong silk 
thread, strong piece of tape i m. long, artery and compres- 
sion forceps. 

Technic. The operation is carried out on the recumbent 
animal under complete anaesthesia, the upper hind foot be- 
ing drawn forward or otherwise so fixed as to not obstruct 
the field of operation. The point of operation is determined 
by the character of the disease and the object to be attained. 
It may be made at any point from the glans penis to the 
attachment of the corpns cavernosnm to the ischium. If 
possible amputate in front of the preputial ring. After the 
penis is drawn out, and the preputial region is carefully 
cleansed with brush and soap, an assistant grasps it just be- 
hind the preputial ring with the hand and holds it firmly. 
A temporar}^ elastic ligature, p, is then applied in front of the 
hand around the penis, or the ])iece of tape is looped around 
it above the hand and it is made to serve both as a tour- 
niquet and as a means for holding the penis, and it is then 
excised by a circular incision about 5 cm. in front of the 
elastic ligature, or immediately in front of the preputial 
ring. The dorsal blood vessels of the penis are ligated sep- 
arately. The urethra, 2c, lying on the ventral side of the 
penis, covered by the corpus cavernosum of the urethra, is 
dissected out of the urethral groove for a distance of about 
2 cm., its dorsal wall slit and the mucous membrane sutured, 
spread out fan-like to the surrounding tissues. The urethra 
can also be slit dorsally and ventrally and the halves sutured 
to the left and the right. A silk ligature, //, is applied to the 
corpus cavernosum, r, just above the point of excision of the 
penis and the elastic ligature then removed. After a few 
days the silk ligature is also removed. 







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VAGINAL OVARIOTOMY IN THE MARE. 



97 



26. VAGINAL OVARIOTOMY IN THE MARE. 
Figs. 10, 11 and Plate XV. 

Objects. The alleviation of vice when related to ovarian 
irritation or disease. 

Instruments. Colin 's scalpel, ratchet ecraseur, 55 cm. 
long. 

Technic. The vnlvo-vaginal canal of the mare is unique 
in its physiological behavior. Under venereal excitement or 
the introduction of the operator's hand or of tepid water the 
organ has the power of " ballooning " or dilating to a degree 
not seen so far as we know in other animals ; the walls be- 
come erected, hard, and stand apart from each other, filling 
the pelvic cavit}^ the vaginal walls resting firmly against the 




Fig. 10. Special spraying ecraser, 55 cm. long. 




Fig. II. Colin 's scalpel. 
pelvic bones at every part except at the points where the blad- 
der and rectum intervene and these organs are pressed out flat 
and occupy a minimum space. In the quiescent state the 
vaginal walls are in contact and from the perinaeum forward 
to within about 10 cm. of the uterine os, the vulva and vagina 
are connected above with the rectum by the pelvic connec- 
tive tissue, while anterior to this point the vagina is covered 
by peritoneum, and it is in this area that the incision needs 
7 



Pirate XV. 

Vaginal Ovariotomy in thk Mare. 

Diagrammatic sagittal section through the 
"ballooned " vagina. V, vagina ; OA, operative 
area ; I, point of incision ; U, uterus ; R, rectum ; 
A, aorta with dotted lines posteriorly to indi- 
cate location of the iliacs. 




Lc 



VAGINAL OVARIOTOMY IN THE MARE. lOi 

be made in the operation. The ballooning of the vagina 
profoundly alters the relation of this operative area, OA, 
Plate XV, and changes it from the horizontal in the quies- 
cent organ to the perpendicular in the ballooned conditioned. 
These variations permit two methods of operation, on the 
quiescent organ where the incision must be upwards, and on 
the "ballooned " or erected, where it must be directed for- 
wards. We follow the latter, because since the "balloon- 
ing " can always be induced, the operation can thus be made 
uniform in all cases, and we believe it safer and more readily 
performed. The operation should always be performed on 
the standing animal, and stocks constitute the proper form 
of restraint. It can be performed under other means of re- 
straint, even in the recumbent animal, but it is inadvisable 
and greatly increases the difficulties and dangers. Secure 
in the stocks with the head elevated, a rope over the back to 
prevent rearing, straps beneath the body to prevent lying 
down, straps or ropes before and behind the animal to pre- 
vent backward and forward movements, all four feet pinioned 
to the floor, and the tail firml}^ secured and stretched to a 
beam above. 

With soap, water and brush cleanse the tail, perineum and 
vulva thoroughly, being especially careful to remove all 
detachable masses of sebum ; 50 per cent, alcohol may be 
used sparingly to aid in removing this. Too free a use of 
alcohol excoriates the delicate skin. Cleanse the clitoris 
carefully. Follow the washing with a free application of 
1:1000 aqueous sublimate solution to the external parts and 
for a short distance inside the vulvar lips and to the clitoris. 
Do not introduce disinfectants into the health}^ vagina nor 
deeply into the vulva as it will cause severe straining during 
and subsequent to the operation and by injuring the vulvo- 
vaginal mucosa favor subsequent infection of the vaginal 
wound. Wash away the sublimate solution with a tepid .6 
per cent, soda bicarbonate solution, and fill the vulvo- vaginal 



I02 VAGINAL OVARIOTOMY IN THE MARE. 

canal with the same. After tliorough disinfection of the 
hands and arms remove the disinfectants by washing in 
sterile soda solution, which at the same time renders the 
hand unctuous and readily introduced through the vulva. 
Armed with the guarded sterilized scalpel, Fig. lo, intro- 
duce the right hand into the vagina promptly and when it is 
well "ballooned" unsheath the knife and placing it just 
above the os uteri at I, Plate XV, parallel to the long axis 
of the uterus and a few mm. to the right or left of the median 
line, in order to avoid a loose fold of mucous membrane gen- 
erally existing directly on the median line, the blade being 
held vertical, that is the cutting surface parallel to the longi- 
tudinal muscular fibers of the vagina, and guarding the pos- 
siljle extent of its introduction with the thumb and fingers, 
push it directly forward in a straight line with a quick thrust 
through vaginal mucosa, the muscular walls and the peri- 
toneum, until the disappearance of resistance indicates that 
the peritoneum has been penetrated. This is the most criti- 
cal step in the operation. 

If the hand is introduced immediately after the injection 
of the sterile saline solution the vagina will generally be 
found " ballooned " or will quickly become inflated under 
movements of the hand. If the solution is thrown out the 
vagina may collapse and closely invest the hand, in which 
case more soda solution should be injected when it will again 
dilate. If the hand is introduced without the knife, with- 
drawn and then introduced with the knife it will be frequently 
found that the vagina has collapsed and needs a second fill- 
ing with the fluid. Patience until dilation is accomplished 
and promptness to act when attained are prime requisites 
to success. The knife should be pushed through the vagina 
quickly making a clean wound the width of the knife blade, 
when the latter is to be withdrawn and laid aside. It should 
be remembered that in this " ballooned " state, the anterior 
wall of the vagina is but 2 or 3 mm. thick and easily pene- 
trated. Introduce the hand again, push one finger into 



VAGINAL OVARIOTOMY IN THE MARE. 103 

incision, then a second and third finger, and eventually 
holding all the fingers in the form of a cone push the entire 
hand into the peritoneal cavity. Immediately below the in- 
cision and continuous with the tissues involved in the wound 
lies the uterus with a transverse diameter of 4 to 6 cm. 
With the palm of the hand downwards, trace the uterus, 
U, Plate XV, forward a distance of 15 to 18 cm., where it 
ends abruptly in two cornua of about the same size as the 
uterus, which are given off horizontally at almost right 
angles. Trace these to the right and left for a distance of 
14 or 15 cm., where they end obtusely, and 3 or 4 cm. be- 
yond tliis in a direct line, resting upon the anterior border 
of the broad ligament is the dense oval ovary varying in size 
from 2.5 to 7 cm. in diameter. Withdrawing the hand, 
carry the ecraseur enclosed within it through the vaginal 
wound to the region of the ovary, release the ecraseur and 
retrace the parts if necessary, and locating the ovary drop 
the chain over it from above and either grasp it with the 
fingers through the chain from above and draw it into the 
loop or passing one or two fingers around beneath the ovar}^ 
push it up through the loop to be grasped by the thumb and 
index finger above. The chain loop should be of barely 
sufficient size to admit of the easy passage of the ovary. 
Holding the ovary with one hand tighten the chain quickly 
with the other, examine to make sure that a loop of intes- 
tine is not caught, draw the ovary well through and get a 
large portion of the oviduct, and cut off promptly, holding 
to the ovary until carried out through the vulva. Remove 
the other ovary in the same way. Generally it is most con- 
venient to remove the left ovary with right hand and vice- 
versa but both may be removed with either hand. Wash 
awa}^ any blood from external parts, apply sublimate solu- 
tion freely to the vulva, perineum and tail. Keep the pa- 
tient quiet for five or six days, and feed lightly on a laxative 
diet. 



I04 VAGINAL OVARIOTOMY IN THE MARE. 

DANGERS. 

Wounding of the rectum is scarcely possible if care is 
taken not to attempt the incision until the vagina is well 
" ballooned," and then making the stab wound directly for- 
ward. If made upwards when the organ is so erected the 
accident is highly probable, and with the undilated vagina 
where it is necessary to cut upwards the danger is ever pres- 
ent. Its prevention demands that the operator await the 
complete ' ' ballooning ' ' and then make his incision as 
directed. If the wound in the rectum passes through the 
pelvic connective tissue behind the peritoneum it is of little 
consequence, but the operation should be abandoned ; if 
the bowel is opened into the peritoneal cavity the accident 
is fatal. 

Wounding of the iliac arteries, which produces prompt 
death from hemorrhage, results from the incision being made 
upwards instead of forwards either when the vagina is " bal- 
looned" or collapsed. It is most likely to occur with timid 
operators who become nervous, especially when the vagina 
does not "balloon" promptly or the mare is not well 
secured. The accident is wholly unnecessary if the opera- 
tor will await the "'ballooning" and favor it if need be by 
repeated injections of tepid soda solution. When it has oc- 
curred it is generally bcN^ond remed}'. 

Wounding of the uterus may occur when the incision 
is directed downward and ma}^ greatly embarrass the opera- 
tor and confuse him by passing the hand through the incis- 
ion into the uterine cavity. It is to be avoided by carefully 
directing the incision straight forwards ; when the accident 
occurs it is of little consequence beyond the embarrassment 
and may be overcome by again dilating the vagina with 
fresh injections of the soda solution and making a new incis- 
ion, or if preferred the first incision may be corrected by 
placing an index finger against the peritoneum at the upper 
part of the wound, and with a sudden and vigorous thrust 



VAGINAL OVARIOTOMY IN THE MARE. 105 

break through the peritoneum into the cavity. Great care 
must be exercised to make the thrust quickly and vigorously 
or the peritoneum will separate from the adjoining tissues 
and a large cavity be formed between the peritoneal and 
muscular walls of the vagina with a large area of yielding 
membrane which it is difficult to penetrate. It is not very 
safe in such cases to attempt continuing the incomplete in- 
cision with the scalpel, as it is very yielding and pushes 
against neighboring organs before it is penetrated and affords 
no signal to the hand by cessation of resistance when it has 
passed through. 

Incomplete penetration of the vaginal wall is liable to 
occur if the scalpel is dull or the vagina incompletely " bal- 
looned " and flaccid, or if the operator is unduly timid. It 
is best prevented by avoiding the cause as related, and once 
it has occurred it is generally best to again " balloon " the 
organ and make a new incision either to the right or left of 
the first. It may be overcome also by thrusting the index 
finger through the peritoneum as described in the preceding 
paragraph. 

The mistaking of a ball of feces for the ovary has oc- 
curred to inexperienced operators and the fatal error of re- 
moving the portion of the rectum surrounding the fecal pellet 
committed. The blunder is uncalled for ; the fecal ball is 
movaljle in the bowel, the intestine is far more massive than 
the broad ligament, and the ovar}^ is to be definitely identi- 
fied by its being lodged in the broad ligament just beyond 
the end ot the oviduct, which is continuous with the uterus 
and coruna. If, therefore, one traces the uterus forward to 
the coruna, thence along these to the oviducts, and thence 
along the border of the broad ligament to the ovary, as above 
directed, the error will not occur. 

The incision may readily be made too low and pass 
beneath the broad ligament. It is to be avoided by being 
careful to keep close to the median line and above the os uteri. 



io6 VAGINAL OVARIOTOMY IN THE MARE. 

If it occurs the operation nia}' be completed from beneath 
without very great difficulty only that the ovary now lies 
above the hand and must be drawn down from on top the 
broad ligament in order to fix the ecraseur upon it. 

Infection constitutes always the most serious danger and 
is to be avoided by proper securing of the animal, by the 
avoidance of irritant antiseptics in the vagina, by rigid anti- 
sepsis at every stage, and b}^ carrying out the mechanical 
parts of the operation deliberately, vigorously and neatly. 
If infection should occur it will generally take the form of 
pelvic cellulitis with abscesses and rectal stricture. Enemas 
of a normal salt or soda solution affords the surest relief of 
the stricture and impaction in front of it. The abscesses 
must be watched and opened early into the vagina or rec- 
tum, and the case treated internally and locally according to 
general surgical principles. 



VAGINAL OVARIOTOMY IN THE COJV. 107 



27. VAGINAL OVARIOTOMY IN THE COW. 

Objects. Increasing the fat or milk-producing qualities 
and the cure of nymphomania. 

Instruments. Colin's scalpel, vaginal dilator, Miles' 
spaying shears. 

Technic. Confine the cow in the standing position in 
the stocks, securing the head firmly and passing two boards 
beneath the abdomen and sternum to prevent lying down, 
and a rope over the middle of the back to prevent arching 
of the spinal column and straining. 

Wa.sh and disinfect the tail and the perinaeum and flush out 
the vagina with a .5 per cent, solution of carbolic acid or 
lysol at a temperature of about 100° F. Insert the vaginal 
dilator with one hand and push the prolongation at the an- 
terior end into the os uteri. With the other hand elevate 
the handle of the dilator and depress and push forward the 
uterus, thus rendering the roof of the vagina tense and push- 
ing it downward away from the rectum. Carry the scalpel 
into the vagina with the right hand and resting it in the 
oval of the dilator make an incision through the roof of the 
vagina, beginning at a point 8 to 10 cm. posterior to the 
OS uteri and extending backward on the median line for a 
distance of 2 or 3 cm. Be careful to make the incision en- 
tirely through the mucosa, muscle and peritoneum at the 
first cut, since any failure to complete the incision tends to 
cause the peritoneum to separate from the muscular coat 
and form a pocket between tiiem, while the peritoneum be- 
ing very elastic renders it difficult to complete the incision. 
Introduce two fingers through the incision, and reaching 
over the side of the vagina to the right or the left, the right 
or left ovary respectively is recognized lying immediately 
against the vagina somewhat below it, just at the anterior 
border of the pubis, in a mass consisting of the cord-like 
Fallopian tube and the fimbriae of its pavilion. The ovary 



io8 VAGINAL OVARIOTOMY IN THE COJV. 

may be distinguished as a firm oval mass 2 to 4 cm. in length 
and I to 2 cm. in its lesser diameter attached to the broad 
ligament. If not promptly recognized by the sense of touch, 
trace the vagina and uterus with the fingers forwards from 
the vaginal incision to the cornua and follow them as they 
bend upward and then backward to the Fallopian tubes, and 
trace each of them until the ovary is reached, where it is at- 
tached to the broad ligament, just beyond the fimbriated end. 
Grasp the ovary between the index and middle fingers and 
draw it through the incision into the vagina. Introduce the 
scissors with the other hand, and when the ovary is reached 
open them barely sufficient to admit the broad ligament 
between the blades and cut away the ovary along with a 
considerable amount of the broad ligament. It is essential 
that plenty of the broad ligament and Fallopian tube be 
removed with the ovary in order to insure the entire removal 
of the latter, because the accidental leaving of the smallest 
particle of ovarian tissue will cause a development of these 
into abnormally large Graafian follicles, and will tend to in- 
crease rather than decrease nymphomania. Should the ani- 
mal be pregnant the ovary on the gravid side is dragged 
downward and forward out of reach of the operator's fingers, 
and if it is desired to complete the operation it may be neces- 
sary to enlarge the vaginal wound and introduce the entire 
hand, when the ovary can be reached and removed. No 
after care is generally necessary. 

The Dangers are similar to those of the mare. The iliacs 
may be wounded in the same manner as in the mare and is 
preventable by being careful to push the vaginal roof wel 
downwards away from the rectum and pelvic roof. 

A new danger appears in the presence of the rumen, the 
supero-posterior portion of which projects into the pelvic 
cavity when filled with food and if the cut is directed for- 
wards a stab wound readily penetrates its walls with fatal re- 
sults. Make the cut iipivards and backzvards . 



OVARIOTOMY IN THE COW. 109 

28. OVARIOTOMY IN THE COW BY THE FLANK. 

Instruments. Clipping shears, convex scalpel, spaying 
shears, heavy needle and thread. 

Uses. Same as the preceding, applicable to heifers or to 
cows when the vulva is too small to admit the operator's 
hand or in case of diseased vagina or uterus. 

The animal may be secured as in the preceding or con- 
fined in lateral recumbency with the hind legs extended 
backward and tlie anterior limbs forward. To accomplish 
this loop a rope about the two fore feet, another about the 
two hind feet, and drawing upon these, cast the animal and 
.secure it in recumbency with the legs extended and bod}^ 
stretched by fastening the ropes to two strong posts about 
8 to 10 m. apart. The operation may be performed in either 
flank. 

Clip the hair from the upper part of the flank, disinfect 
an area 15 to 25 cm. square and make an incision about 12 
cm. long beginning at a point equi-distant from the anterior 
tuberosity of the ilium, the ends of the transver.se processes 
of the lumbar vertebrae and the last rib and extend it down- 
ward perpendicularly severing the skin and subcutaneous 
muscle. Divide the external oblique muscle in the direction 
of its fibres by means of the scalpel handle or the fingers 
and repeat the process upon the internal oblique muscle after 
which puncture the peritoneum either with the scalpel or by 
means of a sudden thrust with the index finger. Force one 
hand through the opening into the peritoneal cavity and 
search for the ovaries at the same point and by the same 
method as in the preceding operation, that is, locate the 
uterus within the pelvic cavity, between the rectum and 
bladder and trace the former and thence the cornu, oviduct 
and broad ligament to the ovary. The uppermost ovary 
can be drawn out through the wound and cut off with the 
scissors ; the lower one must be held vvith one hand and the 



no OF^ RIO TOM Y IN THE BITCH. 

scissors introduced closed along the arm and when the ovary 
is reached, opened bareh^ sufficient to pass over the broad 
ligament and clip it off. The beginner must always remem- 
ber that the positive means for identifying the ovaries is by 
tracing the uterus from the vagina along its cornua to the 
Fallopian tube and thence to the ovary in tlie broad liga- 
ment. Cleanse the wound and close the skin incision with 
continuous sutures. 



29. OVARIOTOMY IN THE BITCH BY THE FLANK. 

Pl..\TE XVI. 

Instruments. Spaying knife, suiure material. 

Technic. Confine the animal in lateral recumbency, 
preferably upon the right side for a right handed operator, 
the head somewhat depressed, the limbs extended and the 
body well stretched. Clip, shave and disinfect a sufficient 
area in the exposed flank at a point just anterior to and be- 
neath the external angle of the ilium. With one hand grasp 
the skin fold of the flank and render the skin of the region 
tense, while with the other holding the spaying knife like a 
pen make at first a drawing ii.cision from below upward about 
2 to 3 cm. long, ending above at a point slightly below the 
external angle of the ilium, the incision extending through 
the skin and subcutaneous tissues ; without removing the 
knife from the wound elevate the handle and with a quick 
thrust make a stab wound extending through the external 
and internal oblique muscles and peritoneum at a single cut. 
The operator can determine when the peritoneal cavity has 
been entered by the disappearance of resistance. Introduce 
an index finger into the peritoneal cavity, and as soon as 
this has been entered follow directly along the peritoneum 
upward and backward toward the angle of the ilium where 
the uterine cornua lie covered over by the broad ligament. 
The internal generative organs of the bitch are unique among 



OVARIOTOMY IN THE BITCH. 1 1 1 

our domesticated animals. The uterus, U, Plate XVI, is 
very small and physiologicall}^ unimportant, the cornua, 
RUC and LUC, are ample in size and constitute physiolog- 
ically the uterus, the Fallopian tube between LUC and O 
is ver}^ short and surgically could almost be said not to ex- 
ist, the ovary OO is very small, smooth and completely hid- 
den in the pavilion which here constitutes a sac having a 
very small longitudinal opening of 2 to 5 mm. The mo.st 
remarkable feature of the apparatus from a surgical stand- 
point is the great development of the broad ligament which 
is broader than the distance from the lumbar region to the 
abdominal floor, while the uterus and uterine cornua are 
stretched between the vagina, V, and the ovary, O, so that 
they are suspended in the sub-lumbar region with the double 
fold of the broad ligament hanging down like a curtain be- 
tween the parietal peritoneum and the uterus and cornua on 
either side. The broad ligament of the bitch is consequently 
suspended at one point from the sub-lumbar region, at the 
other from the uterus, so that instead of the uterus being sus- 
pended by the ligament the relation is reversed and the liga- 
ment is suspended from the uterus, or rather uterine cornua. 
In Plate XVI the right broad ligament BL' is laid out upon 
the side exposing the right uterine cornu RLTC, while on 
the left side the ligament is divided at about its center and 
the posterior portion BL' is laid out on the flank, while the 
anterior BL is left in its normal position concealing a por- 
tion of the cornu LUC. Unlike our other domesticated ani- 
mals, the broad ligament is heavily loaded with fat which 
gives it an appearance very similar to the omentum, but the 
net-work is far less conspicuous or wanting. The omentum 
also extends back into this region so that the two are in con- 
tact. The ovary being indistinct and hidden is difficult to 
identify directly, and the cornua being covered over by the 
duplicature of the broad ligament is not readily reached, so 
that the finger generally comes in contact first with the broad 
ligament of the uppermost cornu hanging loose in the peri- 



Plate XVI. 

Ovariotomy in the Bitch. 

Abdomen of a non pregnant bitch lying on 
the back with the abdominal floor removed and 
the omentum pushed away. TT, the two pos- 
terior teats ; B, bladder ; V, vagina ; U, uterus : 
LUC, LUC, left uterine cornua with a portion 
of its broad ligament, BL, lying across it ; RUC, 
right uterine cornua with its broad ligament, 
BL^, turned outwards exposing the full length 
of the cornua. On the left side the ligament is 
divided so that the anterior half rests in its nor- 
mal position while the posterior half, BL^, is 
turned back ; OO, ovaries ; R, rectum ; K, left 
kidney ; AA, a line indicating the level of the 
external tuberosities of the ilia. 



O VARIO TOM Y IN THE BI TCH. 1 1 5 

toneal cavity ; engage this between the end of the finger and 
the abdominal wall and draw it out through the wound, 
grasp it and continue drawing upon the folds of the liga- 
ment, especially upon the median or undermost portion until 
the naked cornu appears through the opening, seize it and 
draw out the anterior portion until the ovary follows, then 
grasp the ovary firmly with the thumb and index finger of 
one hand and the ovarian ligament with the same members 
of the other hand and tear the ligament through between 
them by linear tension. Extend the tear through the 
broad ligament as high toward its lumbar attachment as 
is convenient and backward to the neighborhood of the uter- 
ine bifurcation. Draw upon the exposed cornu until the bi- 
furcation appears, when the other cornu is to be grasped and 
drawn out through the opening. In young puppies the 
securing of the second cornua is very difficult and requires 
great care to prevent its rupture. The object may be facili- 
tated by pressing the upper flank of the bitch downward, 
thereb}' greatly diminishing the transverse diameter of the 
abdomen. 

The succeeding operation, 30, avoids this difficulty in a 
large measure. Should the distal cornu be ruptured and 
with its ovary drop away from the operator, it becomes nec- 
essary to turn the animal over and make a second incision 
on the opposite side, somewhat further forward. When the 
second cornua has been secured draw it out as far as practica- 
ble and holding it tense insert an index finger along it until 
the ovary is reached, which is recognized by its slightly 
greater size and density succeeding the brief neck represent- 
ing the Fallopian tube between the end of the cornu and 
ovary which are slightly larger, while beyond it, can be felt, 
the ovarian ligament. Engage the ligament between the end 
of the index finger and the abdominal wall, and wnth a firm 
and vigorous movement, using the finger end and nail as a 
curette, rupture the ovarian ligament by drawing the finger 
toward the incision, and with the aid of tension upon the 



ii6 OVARIOTOMY IN THE BITCH. 

corim draw the ovarx^ out through the abdominal incision 
and divide the broad ligament as in case of the other cornn. 
Remove the cornua with the attached ovaries b}' rupturing 
them transversely near the bifurcation b}' means of linear 
tension. 

If the bitch be pregnant and especially if far advanced the 
uterine coronna will lie upon the abdominal floor, much en- 
larged and very much more flaccid than the nongravid uterus 
and feeling very much like intestines. The change in the 
position of the uterus has caused the unfolding of the dupli- 
cature of the broad ligament so that it no longer covers the 
cornu. In such cases the operation is performed in the same 
way except that rupturing the blood vessels by linear ten- 
sion does not insure against hemorrhage and it is necessary 
to ligate the ovarian and uterine arteries with catgut or silk. 
In cases of pregnancy the entire cornua should be drawn 
out and a strong ligature placed around the uterus or vagina ; 
and the ovaries, uterine cornua and their contents be re- 
moved €71 viasse. Release the upper posterior limb and close 
the cutaneous wound by a continuous suture. 

Dangers. Rupture of the uterine cornu alluded to above. 

The ureter may be mistaken for the cornu but is smaller, 
is closely attached to the abdominal walls, and does not 
have the broad ligament with its large deposit of fat. The 
kidney is far larger than the ovary, more exposed, and 
located more anteriorly. 

The iliac arteries are at times caught and ruptured b}' the 
finger but the blunder is uncalled for except through nervous- 
ness of the operator. 

Unauthentic instances of puncturing the bladder in mak- 
ing the incision have been reported and ma}^ be possible. 
If the bitch has been led out and caused to urinate prior to 
operating, the accident is made practically impossible. 



O VA RIO TO 31 Y IN THE BI TCH. 1 1 7 

30. OVARIOTOMY IN THE BITCH BY THE LINEA ALBA. 

Plate XVI. 

Instruments. Same as in the preceding. 

Technic. Confine in the dorsal position with the head 
sharply declined. Shave and disinfect an area on the median 
line about 6 cm. square extending forward from the pubic 
brim. Make an incision on the median line about 4 cm. 
long beginning just in front of the pubic brim and extending 
forward cutting entirely through the skin, the linea alba and 
peritoneum at a single stroke. Insert an index finger and 
identify the uterus or broad ligament by its location and 
form. The finger usually comes in contact first with the 
urinary bladder which may more or less obstruct the pas- 
sage to the uterus according to its dtgree of distension. 
When empty as shown at B, it offers practicall}' no obstruc- 
tion. When very much distended it may be evacuated by 
gentle pressure with the fingers. The operator should be 
careful not to draw the bladder out through the incision as 
its replacement may prove difficult and its puncture with the 
hypodermic needle or an enlargement of the incision ma}' be 
necessary in order to bring about its return. Push the 
bladder aside if necessary and just above it and below the 
rectum the uterus should be readily distinguished and either 
it or the broad ligament caught by the finger and brought 
out through the incision after which the operation proceeds 
in the same manner as by the flank method. It has a dis- 
tinct advantage over the flank method in that in puppies 
there is not so much difficulty in bringing out the ovaries, 
nor the danger of the rupture of the cornua and the ovary 
dropping back. By the use of retractors in the abdominal 
inci.sion the operator is enabled to ,ee the uterus in position 
and grasp it by means of forceps, obviating the necessity of 
introducing the finger into the peritoneal cavity. The sut- 
ures must extend entirely through the abdominal wall and 
be carefully placed in order to prevent hernia. Interrupted 
sutures are preferable. If the operation has been properly 



1 1 8 O VARIO TOM Y IN THE CA T. 

performed no bandage is necessary and the patient will not 
distnrb the sutures. If asepsis has not been strictly fol- 
lowed infection may occur and the consequent irritation 
cause the patient to tear the sutures out, which may lead to 
protrusion of the intestines or other abdominal viscera. If 
the sutures do not include the deeper layers of the abdominal 
wall hernia is liable to occur and require a second operation. 



31. OVARIOTOMY IN THE CAT. 

Instruments. Same as for the bitch. 

Technic. The cat may be spayed by either the flank 
method or through the linea alba. The point of incision in 
either case is the same as in the bitch but owing to the 
smaller size of the animal it is necessary to make the wound 
quite small. Tlie abundance of hair or fur in the region 
renders it essential that an ample area be shaved and the 
surrounding hair be saturated with a disinfectant and care- 
fully brushed away from the operative area. The cat being 
more subject to infection than the bitch the aseptic precau- 
tions must be of the strictest possible character. The opera- 
tive area must be thoroughly disinfected and cleansed and 
equal care must be taken not to introduce irritant disinfect- 
ants into the wound. A ^reat dano^er also exists in the ten- 
dency of the abdominal muscle layers to readily become 
separated by pressure from the finger and form a pocket in 
which wound discharges accunnilate and constitute a danger- 
ous seat for infecticju. Great care must therefore be taken to 
make a clean incision directly into the peritoneal cavity and 
to avoid separating the peritoneum from the nuiscles or the 
muscular layers from each other. The uterus and ovaries 
of the cat are naked and far more easily distinguished than 
in the bitch, there being no extra deposit of fat in the broad 
ligament. The sutures are to be applied to the wound in 
the same manner as in the bitch. 



TENOTOMY OF THE FLEXOR PEDIS TENDONS. 119 

IV. OPERATIONS ON THE EXTREMITIES. 

32. TENOTOMY OF THE FLEXOR PEDIS TENDONS. 

Pi. ATE XVII. 

Objects. The relief of contraction of the flexor tendons 
of the foot. 

Instruments. Razor, sci.s.sor.s, sharp tenotome, bandage 
material. 

Technic. Tenotoni}^ is generally performed on the deep, 
or flexor pedis tendon, seldom on the snperficial, or flexor 
of the OS coronae of the foot. 

Confine upon the operating table with the affected 
member undermost and the foot fully extended. In default 
of a table confine in lateral recumbency and apply an exten- 
sion splint to the foot as shown in Plate XVII. 

On the median side at the middle of the metacarpus the 
skin is shaved and disinfected over the tendon of the flexor 
pedis muscle. The location named lies between the lower 
extremity of the great carpal sheath above and the superior 
extremity of the tendonous sheath of the fetlock below, so 
that neither of these is wounded during the operation, but 
the tendon is severed at a point where it is invested by loose 
connective tissue which retains the divided ends in their 
normal line of direction, somewhat fixed, and favors their 
ultimate reunion. 

Grasp the metacarpus in this area from above and behind 
in such a manner that the thumb rests upon the median or 
upper surface of the metacarpus, and the index and second 
fingers on the lateral or under sideof the flexor pedis tendon. 
While the left thumb pushes the skin toward the metacarpal 
bone, that is, forward, a sharp pointed tenotome held per- 
pendicularly in the right hand is introduced with the cutting 
€dge toward the hoof through the skin, subcutem and anti- 




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W 
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O 



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PERONEAL TENOTOMY. 121 

brachial fascia down to the flexor pedis tendon. Immedi- 
ately on the anterior border of the tendon insert the tenotome 
so far that the point of it can be felt on the lateral or outer 
side through the skin with the left hand. The cutting edge 
of the knife is then turned against the tendon of the flexor 
pedis, that is, it is directed backward, the foot is extended 
by an assistant with the aid of a rope bound around the 
pastern and looped over the hoof, and the extensor pedis 
tendon is cut through under light pressure, by the operator 
pressing downward on the handle of the knife, using the 
metacarpus or suspensor}^ ligament as a fulcrum upon which 
the back of the tenotome rests as a lever, A loud crackling 
as well as the disappearance of resistance by extension shows 
that the tendon is severed. By keeping as close to the an- 
terior border of the tendon as possible we can avoid injury 
to the common digital artery, the internal cutaneous vein, 
and the internal and external interosseous veins which run 
between the flexor pedis and the suspensory ligament. 

After the removal of the knife and after seeing that there 
is a wide space between the ends of the tendon, the foot is 
unbound from the splint and a bandage applied to the meta- 
carpus, which rests upon the fetlock joint and remains in 
position for eight days. Healing of the cutaneous wound 
by primary union. 



33. PERONEAL TENOTOMY. 
Plate XVIII. 

Object. The relief of Stringhalt. 

Instruments. Razor, scissors, sharp tenotome. 

Technic. On the lateral side of the metatarsus a triangle, 
d, opening toward the tarsus is formed by the tendons of the 
extensor pedis longus muscle, /, and the lateral extensor of 
the foot, <?, which unite on the anterior surface of the middle 
of the metatarsus. The synovial sheath of the extensor 



Pirate XVIII. 

PeroneaIv Tenotomy for Stringhai^t. 

Right hind foot seen from the external side. 
The skin covering the lateral extensor of the 
foot is laid back in the form of a flap, the crural 
fascia divided, e. Peroneal tendon ; f, crural 
fascia ; /, tendon of the anterior extensor pedis 
muscle ; d^ the triangle formed by / and e. 



CUNEAN TENOTOMY. 125 

pedis longns muscle extends inferiorh' to near the point of 
juncture of the two tendons ; the sheath of the lateral ex- 
tensor ends below 3 to 4 cm. above the point of union. In 
the middle of this space without a sheath, which is 3 to 4 
cm. long, and below the annular ligament of the hock the 
operation is carried out. After the skin has been shaved 
and disinfected, confine in the stocks or operate upon the 
standing horse, with the aid of local anaesthesia, a twitch 
being applied to the nose and the opposite hind foot held up 
with the side-line. The tendon of the lateral extensor is 
easily felt under the skin as a hard cord about .7 to i 
cm. in diameter. Stretch the skin and with the back of 
the hand toward the hock grasp the tendon with the thumb 
and index finger of one hand, insert the tenotome with the 
cutting edge toward the foot perpendicularl}' upon the tendon 
through the skin, subcutem and aponeurosis derived from the 
crural fascia ; push it from before backward under the tendon, 
turn tiie cutting edge against it, and with the hock extended 
sever the tendon as well as the fascia through to the skin. 
In accomplishing the section of the tendon the knife is to be 
used as a lever of the first class with the anterior border of the 
metatarsus acting as a fulcrum. If the tendon has been 
completel}^ severed its retracted ends ma}' be felt under the 
skin I to 2 cm. above and below the wound. After the op- 
eration an antiseptic bandage is applied, resting upon the 
fetlock. The bandage should remain eight days and the 
cutaneous wound heal bv first intention. 



34. CUNEAN TENOTOMY. 
PI.ATE XIX. 

Objects. The relief of spavin lameness and as an adjunct 
to peroneal tenotomy for stringhalt. 

Instruments. Razor, scissors, straight scalpel. 

Technic. Most horses can be operated on standing, with 
the aid of cocaine, otherwise cast, or secure on the operating 



PI.ATE XIX. 

CuNEAN Tenotomy. 

For the relief of spavin lameness, and as an 
adjunct to peroneal tenotomy in stringhalt. 
CT, cunean tendon. The dotted line crosses the 
ergot. 



NEUROTOMY. 129 

table, on the affected side and extend the tarsus. Shave and 
disinfect an area 5 to 6 cm. square on tlie inferior median 
surface of the hock over the course of the cunean tendon of 
the chief flexor of the metatarsus, as indicated in Plate XIX. 
Ivocate the tendon, CT, by palpation as it passes obliquely 
downward and backward and make a transverse incision 
about I cm. below the inferior border of the tendon at a 
point midway between the anterior and posterior borders of 
the hock, or slightly anterior thereto, the width of the scal- 
pel blade. Push the tenotome flatwise between the skin and 
tendon, as shown in the plate, force it upwards to the superior 
border of the tendon, then turn the cutting edge toward it 
and elevating the handle, using the superior border of the 
wound as a fulcrum, cut the tendon through from without 
inwards. By firm pressure upon the tenotome in the latter 
method periosteotomy is simultaneously accomplished. The 
completion of the operation is evidenced by the separation 
of the cut ends of the tendon leaving a well-marked de- 
pression at the point of operation. Disinfect the wound, 
apph^ an antiseptic bandage resting upon the fetlock and 
allow to remain undisturbed for six days. Healing by 
primar}' union. 

NEUROTOMY. 

General Remarks. Neurotomy is performed for a vari- 
ety of objects, such as the relief of pain in a sensitive nerve 
itself, as in trifacial neurotomy, 11, p. 48, the relief of 
pain or lameness in a par: supplied by a sensory nerve, or 
the inhibition of motor power, as in the " cribbing" opera- 
tion. 

The following neurotomies are designed to relieve pain 
and the consequent lameness dependent upon a pathologic 
condition of some part or tissue on the distal side of the 
point of operation and to which the divided sensory nerve is 
destined. 
9 



I30 NEUROTOMY. 

Neurotoiny of a sensory nerve is always a painful opera- 
tion, anrl its performance without anaesthesia is unjustifiable 
from a humane standpoint, and cannot be so well done either 
from the view of mechanical correctness or the carrying out 
of antiseptic standards. Some neurotomies can be well per- 
formed on the standing animal if it is quiet and the operator 
is experienced, the parts being rendered insensitive by 
means of cocaine or other local anaesthetics ; in the greater 
neurotomies general anaesthesia is called for, whether viewed 
from the humane or operative standpoint. 

The confinement of animals for neurotomy on the sensor}' 
nerves of the extremities for the relief of lameness is always 
to be viewed as a critical procedure for the reason that the 
operation is generally made because of the local manifesta- 
tion of a more or less general disease which is accompanied 
by fragility of the skeleton, and as a result most casting acci- 
dents occur in cases of confining for neurotomy or firing in 
cases of lameness belonging to the great group of dry 
arthritis or spavin family. Casting must, therefore, be done 
with the greatest possible care, a id the operating table is to 
be constant!}' and greatly preferred. 

Neurotomy is properly a last resort in lameness and should 
not otherwise be perfi^rmed. It has two great and ever 
present dangers. If the part deprived of sensation is too 
badly diseased to bear the weight and resist the insult result- 
ant upon the part being called to do its normal or even an 
extra amount of work, it must ultimately give way. the 
bones become fractured, the tendons separate from the bone, 
the intra-ungular tissues lose their integrity and the hoofs 
become detached ( exungulation) or other degenerative 
changes take place as a result of causing a part to do a work 
for which its condition unfits it. 

The second great danger occurs from wounds or other 
tratimatisms to the tissues distal to the operation when the 
unnerved parts are not rested as they would be in natural 



NEUROTOMY. 131 

conditions when injured and as a result reparative changes 
are prevented and supplanted by retrograde processes with 
ultimate death of ihe part and of the animal. 

Nerves are generally accompanied by satellite arteries and 
veins which are always liable to be wounded during the 
operation and are more embarassing because of the hemor- 
rhage clouding the operation field and inviting error than 
dangerous because of the loss of the blood itself. It is essen- 
tial to a good operation that the hemorrhage be kept under 
control throughout so that each tissue will stand out in good 
relief and the nerve reveal its identity in addition to its loca- 
tion, size and relations, by its intensely white, nacrous, 
striated character. The test of compressing the nerve in 
order to identify it by the resultant pain is unsurgical and 
unnecessaril}^ cruel. 

Sepsis holds an important place in considering the dangers 
of neurotomy because the infection of a sensitive nerve 
causes very great pain and if considerable tends to cause a 
false neuroma or fibroma in the connective tissue of the 
nerve trunk, calling for a second operation in order to re- 
move the tumor, and resultant lameness. 

Neurotomies should consequently be performed onl}' in 
properly selected cases, the smallest possible trunk that will 
sufficienth' relieve the pain should be selected for the opera- 
tion, it should be performed with due regard for suffering 
and for asepsis, should be performed quickly and neatly, the 
incisions being free, laying the nerve trunk bare without 
tearing up the tissues and clouding them and at every point 
aim at celerity, accuracy and neatness. 



132 DIGITAL NEUROTOMY. 



35. DIGITAL NEUROTOMY. 
PI.ATE XX 

Objects. The relief of navicular lameness in cases where 
plantar neurotomy is not deemed necessary or advisable. 

Instruments. Razor, scissors, scalpel, probe pointed 
bistoury, tenacula, aneurism needles, bandages. 

Technic. Digital neurotomy may generalh' be perform- 
ed on the standing animal, the operative area having first 
been anaesthetized by means of cocaine or otherwise, a 
twitch applied to the upper lip and the affected foot held up 
b}' the assistant. If necessary because of restlessness of the 
animal or inexperience of the operator, confine on the oper- 
ating table or cast the animal and apply the extension splint 
to the foot to be operated on as shown in Plate XVII, except 
that the lower binding cords rest on the metacarpus instead 
of the pastern. Extending downwards from the fetlock 
joint toward the coronet, between the posterior border of 
the phalanges and deep flexor tendon there is a slight furrow, 
at the posterior part of which, close to the external margin 
of the tendon, lies the median or principal digital nerve ac- 
companied in front by the digital artery, A, anterior to 
which lies the digital vein, V. Immediately behind the 
nerve and generally lying a trifle deej)er, is quite commonly 
found a second venous trunk of considerable size. Near the 
middle of the first phalanx the nerve is crossed externally 
in an oblique direction from above to below and from behind 
to before by a white ligamentous band, L, slightly broader 
than the nerve extending from the base of the ergot of the 
fetlock to the retrossal process of the pedal bone. This nuist 
not be mistaken for the nerve, N, and need not be if it is re- 
membered that the latter is accompanied on tlie same plane 
and in a like direction by the satellite artery, A, and vein, V, 
enclosed with it in a fibrous sheath. At the uppermost part 



DIGITAL NEUROTOMY. 133 

of the first phalanx the nerve lies in front of this ligament, 
a short distance inferiorly it passes beneath it, while from 
the middle of the pastern downwards the nerve lies behind 
the ligament. 

The operation is practicable at an}^ point over the line of 
the nerve from the top to the bottom of the shaved area in 
Plate XX or from the superior end of the first phalanx down 
to a level with the superior border of the lateral cartilage, 
but perhaps preferably at about the middle of the pastern. 
At the desired point and over the groove between the flexor 
pedis tendon and the phalanges shave and disinfect an area 
4 to 5 cm. square. In the center of this area at the anterior 
border of the flexor tendon, with the scalpel held perpen- 
dicular to the skin, make an incision from above downwards 
a distance of from 2 to 3 cm. cutting cleanly through the 
skin and subcutaneous fascia down upon the nerve. The 
incision is favored by tensing the skin between the thumb 
and index finger of the left hand, but care should be taken 
not to displace it backwards or forwards. Dilate the wound 
by pressure with the thumb and index finger or otherwise 
and carefully incise longitudinally the fibrous sheath en- 
veloping the nerve and artery. Pass an aneurism needle 
beneath the nerve, and follow with a second aneurism needle 
immediately beside the first. Draw the two apart, one 
toward the toe, the other toward the fetlock, and separate 
thereby the nerve from the surrounding tissues. Remove 
one aneurism needle, insert a probe pointed scalpel, or scis- 
sors beneath the nerve, and divide it at the upper angle of 
the wound and excise a section of nerve 3 cm. long. Disin- 
fect and bandage with or without suturing the wounds. 
Leave the bandage in place 6 to 8 days. 



PI.ATE XX. 

DiGiTAi, Neurotomy. 

V, digital vein ; A, digital artery ; N, digital 
nerve ; h, ligament. 




-N 



PLANTAR NEUROTOMY. I37 

36. PLANTAR NEUROTOMY. 

PLATE XXI. 

Objects. The relief of navicular lameness or other pain- 
ful non-suppurating diseases of any parts below the fetlock 

joint. 

Instruments. Razor, scissors, convex scalpel, compres- 
sion artery forceps, tenacula, aneurism needles, suture ma- 
terial, elastic ligature. 

Technic. It is well to apply a bandage saturated with 
sublimate or creolin solution to the fetlock joint 24 hrs. 
before the operation in order to secure thorough disinfection. 

Confine the animal and fix the limb as in the preceding 
operation. After the removal of the bandage, shave the site 
of operation and thoroughly disinfect the region of the 
metacarpus and fetlock with soap, brush, and sublimate or 
creolin solution and 50% alcohol. Passing the fingers from 
before to behind with light pres.sure over the region of the 
fetlock joint, there is felt just in front of the flexor pedis 
tendon a channel-like depression extending from above the 
fetlock downward over it. In this lies the threadlike cord 
of the nerve, ?^, 3 mm. thick, which glides forward under- 
neath the fingers with a distinct recoil. The site of opera- 
tion lies immediately above the fetlock in the posterior third 
of the metacarpus or one may operate at any point higher 
up as far as beyond the middle of the metacarpus or meta- 
tarsus so long as care is taken to include the anastomosing 
branch given off by the median plantar nerve at about the 
middle of the metacarpus and bending obliquely around 
behind the tendons to join the lateral nerve somewhat lower 
down. At this point stretch the skin between the thumb 
and index finger of one hand and make an incision 3 to 5 
cm. long, the lower angle of which is just above the fetlock 
joint, cutting directly through the skin, subcutem and con- 



Plate XXI. 

Plantar Neurotomy. 

a, lateral digital artery ; v, lateral digital vein ; 
n, common lateral digital nerve ; d, anterior 
branch ; o, posterior branch ; s, superficial flexor 
tendon ; p, perforans tendon ; i, suspensory 
ligament of fetlock ; ni, metacarpus. 



NE URO TO MY OF THE MEDIAN NER VE. 141 

nective tissue sheath down 011 to the nerve, laying it bare. 
The borders of the cutaneous wound are held apart with 
tenacula and b}- palpation with the fingers or by vision it is 
determined if the nerve lies in the middle of the wound. If 
necessar}' continue the dissection with the scalpel until the 
nerve is clearly revealed ; it is distinguished by its faintly 
yellowish color, its fine longitudinal striae and its location 
behind the metacarpal arter3^ Immediately above the fet- 
lock joint the median metacarpal or metatarsal nerve divides 
into an anterior smaller, d, and posterior larger, 0, branch. 
This division should be laid bare in order that the operator 
may not erroneously cut one branch onl3^ Immediately 
above this point of division the aneurism needle is passed 
under the nerve, then a second needle is inserted beside it 
and the two pulled apart separating the nerve from the ad- 
jacent tissues, the scissors or a small probe-pointed bistoury 
is passed beneath and it is cut through quickl}^ at the superior 
angle of the wound. The distal end of the nerve is then 
di.ssected free as far as po.ssible downward and l)oth branches 
excised at the lower angle of the wound so that a section 
3 to 5 cm. long is removed. The cutaneous wound is united 
by a continuous suture and a temporary bandage applied. 
The extension splint, if it has been used, is then removed, 
the foot replaced in the hobble and the horse turned to the 
other side. Neurotomy of the opposite metacarpal nerve is 
carried out in the same way after which a sterile bandage is 
applied and allowed to remain eight days. Healing by 
primary union. 



37. NEUROTOMY OF THE MEDIAN NERVE. 
PI.ATE XXII. 

Objects. The relief of lameness due to disease so located 
in the anterior limb that it cannot be overcome by plantar 
neurotoni}'. 



142 NEUROTOMY OF THE MEDIAN NERVE. 

Instruments. Razor, scissors, convex scalpel, artery 
and compression forceps, tanacula, aneurism needles, suture 
material. 

Technic. The operation is performed on the median 
surface of the anterior limb immediately below the humero- 
radial articulation on the recumbent horse after the affected 
foot has been fully extended on the operating table or in de- 
fault of this removed from the hobbles and bound upon the 
extension splint as shown in Plate XVII. Anaesthetize. 
The foot is drawn out firmly from the shoulder, inclined 
somewhat forward. Tiie operator places himself between 
the neck and the forearm and, after the median region of 
the elbow joint has been washed with soap and water, 
searches for the median nerve where it glides over the pos- 
terior part of the joint to disappear behind the radius. 
Shave the skin at and below tiiis point, disinfect it with 
soap, sublimate or creolin solution and 50% aclohol. The 
nerve, 71, lies as a rule somewhat in front of the middle of the 
median side of the forearm against the postero-internal 
margin of the radius and can be felt, about 5 to 6 mm. in 
diameter, lying somewhat deeply. The position of the nerve 
varies with the different attitudes of the forearm. In fat 
and fleshy horses the identification of the nerve is more 
difficult. It may be felt upon the standing animal. 

With tlie nerve lying between tiie tliumb and index finger 
of the left hand, at the point where it begins to disappear 
behind the radius after having passed over the humero-radial 
articulation stretch the superposed skin and innnediately 
upon and parallel to it make an incision 5 cm. long, first 
through the skin, then tlirough the sterno-aponeuroticus 
muscle. Any hemorrhage from the skin, subcutis, or mus- 
cle, is checked. The tenacula are inserted cautiously in the 
lips of the wound, and these being drawn apart the white 
anti-brachial fascia is brought into view and a search is 
made with the index finger to determine the exact location 



NE VRO TOM V OF THE MEDIAN NER VE. 1 43 

of the nerve, and the fascia is divided with the scalpel and 
an oval piece excised with the scissors immediately over it. 
If much fatty tissue is found between the layers of fascia it 
may be dissected away carefully with the scalpel or cut away 
with the scissors. Tiiere now comes to view a delicate red- 
dish colored fascia-like membrane, the nerve sheath, behind 
which a blue cord, the brachial vein, V, is visible, the latter 
being intimately connected with the nerve sheath. The 
veMi lies mostly behind and beneath the nerve and may pro- 
ject out from beneath the anterior border of the same. The 
operator needs be careful not to prick this vein with the 
tenacula, as the hemorrhage therefrom is exceedingly annoy- 
ing during the operation. It is best to avoid the use of 
tenacula after penetrating the fascia and retract the wound 
lips cautiously with the aneurism needles instead. Still 
further forward and deeper may be felt the pulsating brachial 
artery. Incise the nerve sheath carefully and divide it upward 
and downward with the scalpel or scissors, whereupon the 
yellowish and distinctly fibrous nerve comes into plain view. 
Pass an aneurism needle beneath tiie nerve then pass another 
alongside the first and drawing the two apart separate the 
nerve from the adjacent tissues throughout the lengtli of the 
wound. Be careful to not cut the nerve too high aiid errone- 
ously include the motor nerve of the flexor of the metacarpus 
and the flexors of the foot, which are generally given off pos- 
teriorly just below the humero radial articulation. Lift the 
nerve up and cut it througli at the superior angle of the 
wound by a sudden clip with the scissors or witli the probe 
pointed scalpel. Lay the peripheral end of the nerve bare 
to the lower angle of the wound, and excise at least 3 cm. 
of it. Tamponade the wound with dry iodoform gauze and 
approximate the skin with a continuous suture. The tampon 
and sutures remain from i to 2 days. 

Since sen.sation of the lower part of the limb is partly 
maintained by the deep branch of the ulnar nerve which at 



PI.ATE XXII. 

Median Neurectomy. 

Median surface of the right humero-radial 
articulation, «, brachial artery ; n, median 
nerve ; v^ brachial vein ; f, antibrachial fascia ; 
p, sterno-aponeuroticus muscle. 




lO 



NEUROTOMY OF THE ULNAR NERVE. 147 

the lower part of the carpas, covered by the tendon of the 
obhque flexor becomes the lateral plantar nerve, neurotomy 
of the median nerve does not completely effect the desired 
end. In order to produce complete anaesthesia, therefore, 
from median, it is necessar}' at the same time to perform 
ulnar neurotomv. 



38. NEUROTOMY OF THE ULNAR NERVE. 

PL.ATES XXIII AND XXIV. 

Objects. An adjunct operation to the preceding by 
which the enervation of the carpus and foot is completed. 

Instruments. Same as in the preceding. 

Technic. Above and l3ehind tiie carpus there may be 
felt a groove between the external and middle flexors of the 
carpus, EF and OF, Plate XXIV. At this point 10 cm. 
above the pisiform bone the skin is .shaved and disinfected 
and an incision 6 cm. long made through the skin and 
antibrachial fascia. This incision extends just outside the 
median line of the posterior surface of the radius in such a 
way that the superior angle of the wound is about i cm. 
farther outward than the lower. Beneath the fascia betw^een 
the aforesaid muscles is seen the ulnar nerve, Plate XXIII, 
n, Plate XXIV, NU, on the median or inner side of it 
the collateral ulnar vein, Plate XXIII v, and between the 
two and .somewhat deeper the collateral ulnar artery, a. 
The nerve, about 3 mm. in diameter is picked up with the 
aneurism needle, severed at the upper and lower angles of 
the wound, tlie lips of the w^ound united by a continuous 
suture and a bandage applied. Healing by first intention. 



Plate XXIII. 

Ulnar Neurotomy. 

Right forearm seen from behind, e, external 
flexor of the carpus;/, oblique (middle) flexor 
of the carpus ; a, collateral ulnar artery ; b, anli- 
brachial fascia ; ?/, ulnar nerve. 



Plate XX I v. 

Ulnar Neurotomy. 

Cross section through the radius of the limb 
about lo cm. above the pisiform bone, viewed 
from below. EF, external flexor of the carpus ; 
OF, oblique flexor of the carpus ; NU, ulnar 
nerve ; NM, median nerve. Lying on its median 
side is the ulnar artery, the satellite vein of 
which is not shown. 



SCI A TIC NE URO TOM Y. 153 

39. SCIATIC NEUROTOMY. 
Plates XXV and XXVII. 

Objects. The destruction of sensation in the tarsus and 
parts be3'ond for the relief of otherwise incurable spavin 
lameness, diseases of the tendons, etc. 

Instruments. Same as in the preceding. 

Technic. Place the animal on the operating table on the 
diseased side, extend the affected limb and draw the upper 
leg forward and secure it out of the way. Produce complete 
general anaesthesia. The posterior tibial or sciatic nerve ;^, 
Plate XXV, and NS, Plate XXVII, is then sought by grasp- 
ing the leg with the left hand from behind in such a manner 
that the thumb rests above and the fingertips below it. 
Reaching forward with the fingers to the deep flexor of the 
foot grasp the leg with moderate firmness and draw the hand 
slowly backward. Immediately behind the perforans muscle 
and between this and the tendo-Acliilles the nerve nearly i 
cm. in diameter glides away forward from between the 
fingers with a distinct recoil. If the nerve can not be found 
in this manner the hock should be strongly extended, by 
which means it is caused to recede from the perforans mus- 
cle, so that it can more readily be felt near the middle of the 
groove extending between it and the tendo-Achilles. At 
this point the skin is shaved, disinfected and an incision 
made through it 5 cm. long, parallel to the tendo-Achilles. 
The white rigidly-stretched crural fascia is now divided in 
the same direction after which it should be determined by 
palpation that the nerve lies in the middle of the wound. 
Excise with the scissors an elliptic or oval piece of the fascia 
or hold apart the fascia along with the lips of the cutaneous 
wound by means of the tenacula. In poor horses the con- 
tour of the nerve covered only by loose connective tissue 
stands out prominently, in fat horses it is surrounded 



PI.ATE XXV. 

Sciatic Neurotomy. 

Right hind leg viewed from the median side, 
y, crural fascia; ;/, sciatic (tibial) nerve; v, 
plantar vein. 



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PI.ATE XXVI. 

Anterior Tibial Neurotomy. 

EP, extensor pedis muscle ; P, peroneus mus- 
cle ; NP, deep branch of the peroneal or anterior 
tibial nerve ; FM, flexor metatarsi muscle. 




1 1 



ANTERIOR TIBIAL NEUROTOMY. 163 

by a large amoiitit of adipose tissue. Cut tlirougli this fat 
and connective tissue and the tibial nerve, ;^, Plate XXV and 
NS, Plate XXVII, is in sight, immediately before it lies the 
plantar vein and on the lateral side is situated the recurrent 
tibial artery SA, Plate XXVII. The cross section in Plate 
XXVII is located somewhat below the point for operation 
and the vein has crossed ol^liquely over the nerve so that it 
appears behind instead of in front of it. as is the case gen- 
erally at the point where the operation is performed. Sep- 
arate the vessels completely from the nerve with the handle 
of the scalpel, pass two aneurism needles from before back- 
ward beneath it and drawing these apart separate the nerve 
trunk from the adjacent tissues and cut it off at the upper 
and lower angles of the wound removing a section at least 
5 cm. long. Suture the cutaneous wH)und and apply a 
bandage allowing it to remain eight days. Healing b^^ first 
intention. 



40. ANTERIOR TIBIAL NEUROTOMY. 

Neurotomy of the Deep Branch of the Peroneal Nerve. 
Plates XXVI and XXVII. 

Object. An adjunct operation to the preceding as it sup- 
plies .sensation to the tarsus in common with the sciatic. 
The two constitute wiiat is known as Bossi's double neuro- 
tomy for spavin. 

Instruments. Same as in the preceding. 

Technic. Confine as in the preceding but with the 
affected leg uppermost. Locate the furrow dividing the ex- 
tensor pedis longus muscle, EP, Plates XXVI and XXVII, 
and the peroneus muscle, P, Plate XXVI, MP, Plate XXVII, 
and shave and disinfect the skin over an area 6 cm. long by 
3 cm. wide directly over this depression and extending up- 



l64 ANTERIOR TIBIAL NEUROTOMY. 

ward from a point 6 or 7 cm. above the tibio-astragoloid 
articulation. 

At a point 8 to 10 cm. above the flexure of the hock make 
an incision through the skin and subcutis 5 or 6 cm. long 
over the line of division between the two extensors of the 
foot. Superficially the operator passes near by the musculo- 
cutaneous division of the anterior tibial nerve, NMC, Plate 
XXVII, which must not be mistaken for the deep branch. 

The peroneus muscle, MP, Plate XXVII, and P, Plate 
XXVI, is separated from the extensor pedis longus, HP, 
Plates XXVI and XXVII, by a strong aponeurotic sheath 
continuous with the tibial aponeurosis. Penetrate the latter 
anterior to the aponeurotic partition directly against the ex- 
tensor pedis, EP, and passing along its posterior border to a 
depth of 2 to 4 cm., there appears the thin margin of the 
flexor metatarsi magnus FM, Plates XXVI and XXVII, 
which lies immediately against the extensor pedis without a 
visible connective tissue partition but revealing itself by a 
markedly lighter shade of color and its ready separation 
with the scalpel from the extensor. The deep branch of the 
peroneal nerve, NP, Plates XXVI and XXVII. lies loosely 
imbedded on the anterior side of the margin of the flexor 
metatarsus facing the extensor pedis, at times visible at the 
margin, at others placed more deeply reaching in some cases 
a distance from the margin of 4 or 5 mm. Within this 
range is seen the slender nerve trunk almost devoid of 
surrounding connective tissue and measuring about 2 mm. 
in diameter. Pass the aneurism needle beneath it and re- 
move a piece 3 to 4 cm. long. Close the cutaneous wound 
with interrupted sutures and dress antiseptically without a 
bandage. 



RESECTION OF THE LATERAL CARTILAGE. 165 

41. RESECTION OF THE LATERAL CARTILAGE. 
Plate XXVIII. 

Object. The cure of quittor or necrosis of the cartilage. 

Instruments. Elastic ligature, drawing knife, scissors, 
razor, hoof rasp, hoof plane, craniotoni}' or other heavy for- 
ceps for the removal of the horn, artery forceps, elevator or 
long bone chisel, double-edged sage knife, curette, needle 
holder, thread, needles, iodoform ether, iodoform gauze, 
tampons, absorbent cotton, bandages, 

Technic. For a few hours before the operation place 
the affected foot in a bath of creolin solution after having 
first made a semicircular groove in the horn of the lateral 
wall and quarter down to the horny lamina, as shown at 5- 
in Fig. I, Plate XXVIII. 

The operation is performed upon the recumbent anaes- 
thetized animal, in such a position that the diseased cartilage 
of the affected foot lies upward. The operating table consti- 
tutes incomparably the best means of confinement in every re- 
spect. After the application of the elastic ligature the groove 
in the horn is deepened with the drawing knife down to the 
sensitive laminae without injuring them. The groove must be 
so located that it extends beyond the anterior and posterior 
borders of the lateral cartilage, remaining a few cm. distant 
from the bearing surface of the wall and approximately per- 
pendicular to the surface of the horn wall so that it will form 
a secure support for the dressing to be later applied. The 
hair on the coronary band is clipped or shaved and the entire 
foot up to the fetlock joint thoroughly cleansed with brush, 
soap, creolin or sublimate solution and 50 per cent, alcohol. 
The levator or long bone chisel is then inserted beneath the 
lowest part of the semi-circular piece of horn which has been 
isolated, the horn is elevated from the sensitive structures 
somewhat, grasped with the heavy forceps and carefully loos- 
ened from the sensitive laminae by drawing upward parallel 



1 66 RESECTION OF THE LATERAL CARTILAGE. 

to the laminae and then backward from the coronar}^ papillae 
and keraphyllous tissue. After the coronary band has been 
smoothed witli the scissors, make two perpendicular incis- 
ions through the skin of the coronary band and the band 
itself, one behind the anterior and the other in front of the 
posterior border of the groove in the horn and connect the 
two by means of a semi-circular incision in the sensitive 
laminae. This U-shaped incision nuist be so made that be- 
tween it and the horny wall there is left an area of sensitive 
laminae at least 2 cm. wide, in order that there may be sufn- 
cient room in the soft tissues for the appHcation of the su- 
tures, as shown in Fig 2. The isolated flap is now dis- 
sected closely against the os pedis and its ala and later from 
the lateral surface of the cartilage, the operator first lifting 
the flap with forceps, later with the hand. Above the carti- 
lage toward the fetlock the operator must keep the fingers 
of one hand against the external skin in order to avoid cut- 
ting through it or thinning it too nuich at this point. The 
flap is held turned upwards by an assistant or by a suture. 
As a rule there is now seen a prominent, greenish colored 
necrotic piece of cartilage surrounded by brownish red 
masses of granulations. By means of an incision through 
the cartilage parallel to the axis of the foot, divide it into 
anterior and posterior halves and extirpate the latter first, 
by dissecting it out on the inner side from the parachondrial 
tissue with the double-edged sage knife. The point of the 
knife must be constantly directed against the cartilage. 
Since the inner surface of the anterior half of the cartilage 
lies immediately against the capsular ligament of thecorono- 
pedal articulation the latter should be sharply extended by 
which means the capsular ligament is drawn away from the 
cartilage during its extirpation. The anterior half of the 
cartilage, k, is then removed in the same way, except with 
the greatest po.ssible care to avoid puncturing the corono- 
pedal articulation. Remnants of cartilage at its juncture 



Plate 




Fig. I. 



Resection of the Laterai, Cartilages of the os Pedis. 



Horny wall removed, sensitive laniiiiEe and culaiieous flap held 
upwards. Posterior half of the cartilage excised, f, sensilive 1am- 
in£e ; w^ coronary band ; k^ anterior half of cartilage ; //, cavity 
caused by the removal of the posterior half of the cartilage ; n, necrotic 
cartilage ;/>, parachondral surface of the skin and sensitive laminae ; 
5, perpendicular, crescent-shaped incision in the horny wall \g^ fistula. 



xxvrii. 







Fig. 2. 

Resection of the LateraIv Cartilages of the os Pedis. 

Completed operation showing the sutures in place and the parts 
ready for the application of dressings. 



RESECTION OF THE LATERAL CARTILAGE. 171 

with the retrossal process of the os pedis, and granula- 
tions are to be removed with the curette. Cut away with 
the scissors and knife any remnants of cartilage adher- 
ent to the flap, p, thin if necessary the entire flap and excise 
the fistulous openings, g. After thorough disinfection of the 
entire field of operation return the flap to its former position 
and retain it there by a sufficient number of interrupted 
sutures, Fig. 2, irrigate the wound surface with iodoform 
ether and cover the parts over with iodoform gauze and 
tampons which rest firmly upon the perpendicular wall of 
horn. Finally invest the hoof and pastern up to the fetlock 
joint with oakum and lay a heavy tar bandage over it, the 
turns of which must completely invest it at every point and 
render the dressing iniDermeable to moisture. Remove the 
elastic ligature. If the animal is free from fever, feels and 
eats well, the bandage is left in position from 12 to 14 days. 
Healing by first intention. 



172 RESECTION OF THE FLEXOR PEDIS TENDON. 

42. RESECTION OF THE FLEXOR PEDIS TENDON. 

Fig. 12. 

Object. The removal of necrotic tissues and disinfection 
in cases of infected wounds, chiefly of nail pricks of the 
navicular bursa. 

Instruments. Elastic ligature, drawing knife, double- 
edged sage knife, scissors, tenaculum forceps, curette, 
scalpels, tenaculae, bandage material. 

Technic. Before the operation thin the horn of the sole, 
frog and bars until the soft parts can be seen through them 
and apply an antiseptic bandage saturated in creolin solution 
for 24 hours if time will warrant. Secure the patient on the 
operating table or by casting in lateral recumbency with the 
affected foot extended. Anaesthetize. Cleanse and di.sinfect 
the entire foot with soap, brush, creolin or sublimate solution 
and 50% alcohol and apply the elastic tourniquet in the 
metacarpal or metatarsal region. Make a transverse incision 
through the base of the frog 2 to 3 cm. from the balls 
through the horny and sensitive portions and the fatty 
cushion down to the flexor pedis tendon. Follow this by 
two curved incisions extending forward and inward in an 
oblique direction corresponding to the semi-lunar crest of the 
OS pedis, the line of incision being in the bars about J 2 cm. 
outward from the lateral groove of the frog and uniting at 
its apex. This triangular piece of frog which has been 
isolated by the incision is now grasped with the tenaculum 
and dissected away. As a general rule the operator finds 
that he has not yet reached the flexor pedis tendon but only 
the fatty cushion which covers the latter. The remnants 
of the fatty frog should be removed with the double-edged 
.sage knife or scalpel by means of a horizontal inci.sion, and 
there is then seen the greenish or yellowish colored necrotic 
flexor pedis tendon, which may at times be covered with 



RESECTION OF THE FLEXOR PEDIS TENDON. 173 

reddish colored granulations. Should the operation be in- 
dicated on account of a suppurative pododermatitis the bars 
on the affected side must be excised along with the other 
portions. The position and extent of the navicular bone 
can be determined by feeling through the flexor tendon. A 
transverse incision is then made over the middle of the 
navicular bone through the flexor pedis tendon into the 
navicular bursa, the distal end of the tendon grasped with 




Fig. 12. 
Resection of the Flexor Pedis Tendon. 

Solar surface of the foot, r, Semilunar crest of os pedis ; 
n, OS pedis ; ?', navicular-pedal ligament ; ^, navicular bone ; 
b^ flexor pedis tendon ; t', sensitive laminae of the bars ; st, 
fatty frog \f^ sensitive frog ; /^, horny frog. 

the tenaculum forceps and lifted up from the navicular bone 
with the aid of two lateral curved incisions. Between the 
inferior border of the navicular bone and the semi-lunar crest 
of the OS pedis stretches the capsular ligament of the in- 
ferior articulation between these two bones reinforced by 
dense fibrous bands. The flexor pedis tendon is united to 



174 AMPUTATION OF THE CLA \VS OF RUMINANTS. 

this b}' a few bundles of fibres. Dissect the tendon carefully 
avva}^ from the capsular ligament, avoiding opening the 
articulation, and beyond from the semi-lunar crest of the os 
pedis. If necrotic or discolored pieces of the fatty cushion 
or the tendon still remain, remove these with scissors, scalpel 
or curette. With tiie latter, currette the roughened cartilage 
of the navicular bone and remove any necrotic portions- 
In extensive necrosis of the suspensory ligaments of the 
heel and of the ligaments extending from the fetlock 
joint to the lateral cartilages, the necrotic portions as well 
as the neighboring fatty cushion with its numerous elastic 
fibres, must be resected. Disinfect the operation wound, 
irrigate with iodoform ether and tamponade it with dry 
iodoform gauze. Over this apply a firm pad of oakum, 
enclose the entire hoof up to the fetlock in oakum and 
apply over this a bandage. Over this apply a tar bandage 
and remove the elastic ligature. In the absence of fever 
the bandage remains in position for eight days. 



43. AMPUTATION OF THE CLAWS OF RUMINANTS. 

PI.ATE XXIX. 

Uses. The cure of "foul in the foot" or panaritium 
when complicated with suppurative arthritis or osteitis. 

Instruments. Half round rasp, double-edged sage knife, 
scissors, convex scalpel, nrtery forceps, drawing knife, 
elastic ligature. 

Technic. Cast the animal and secure the foot to be 
operated upon in an extended position, apply the elastic 
ligature after disinfecting the claws with soap, water, brush 
and creolin solution, rasp away the horn on the lateral side 
of the diseased claw, especially at the posterior part of it, 
until the horny wall becomes so thin that it can readily be 
pressed in with the fingers. Anaesthetize. The corono- 



AMPUTATION OF THE CLAWS OF RUMINANTS. 175 

pedal articulation can be felt, about 3 cm. below the coronary 
band, by grasping the claw with the left hand in such a man- 
ner that the thumb rests upon the thinly rasped horn while 
with the other hand the claw is moved from side to side. 
x\t the lowest point of the articulation push the double- 
edged sage knife into the joint, the concavnty of the knife 
being directed toward the fetlock, and make a curved incis- 
ion at first forward and upward to the neighborhood of the 
coronar\^ band, then with strong flexion of the foot a second 
curved incision backward and upward which, however, ex- 
tends only to the navicular bone. By this incision the oper- 
ator divides the horn, tlie sensitive lamina, the external 
corono-pedal ligament and the capsular ligament of the 
corono-pedal articulation. Pass the knife between the na- 
vicular and pedal bones and extend the incision downwards 
perpendicular to the solar surface through it, separating the 
navicular bone from the os pedis. In this manner the na- 
vicular bone is preserved as well as the ball of the heel, the 
latter of which is of special significance in healing. The 
inner wall of the claw with the powerfully developed corono- 
pedal ligament is divided from before backward. After the 
vessels which can be seen are ligated, the articular surfaces 
of the navicular and coronary l)ones curetted and the necrotic 
remnants of tendon removed an antiseptic bandage is applied 
and a tar bandage placed over it for protection. The band- 
age remains for 12 or 14 days. 

If the structures above this point of amputation are 
irremediably involved the digit should be amputated higher 
up, at the articulation of the first and second phalanges or 
through the first phalanx. In these higher amputations a 
flap operation is generally practicable. 



PI.ATE XXIX. 
Amputation of the; Ci.aws of Ruminants. 

Fig. I. d, horny wall, rasped thin ; g, artic- 
ular condyle of 2nd phalanx ; «, b, c, course of 
incision. 

Fig. 2. Median claw preserved. Viewed 
from the solar surface outward. a, external 
corono-pedal ligament ; /, internal do ; k, ten- 
don of the flexor pedis muscle ; g, distal artic- 
ular surface of the 2nd digit ; g\ articular sur- 
face of 3rd digit ; g^^ navicular bone ; /, lateral 
claw ; in, median claw ; b, bulb of the heel. 







Fig. 2. 



12 



THE BA YER SUTURE. 



179 



44. THE BAYER SUTURE. 
Fig. 13 and 14. 

Uses. The closure of large or penetrant wounds with 
convenient and secure means for applying and retaining 
antiseptic dressings. 

Instruments. Large curved suture needle armed with 
strong silk thread, about 20 cm. long, which is doubled and 




Fig 13. 

Retention, and Continuous Approximation Sutures. 

d, d\ d'\ drainage lubes ; <?, retention suture (closed end); e\ open 
end ; b, fixation suture for tiie drainage tube ;/, continuous approxi- 
mation suture. 

passed through the eye in such a manner that the closed end 
extends considerably beyond the cut ends ; small needles 
and thread ; needle forceps ; drainage tubing preferably two 
very large and one small with lateral openings ; thin wooden 



i8o 



THE BA YER SUTURE. 



splints 15 cm. long, 2 to 4 cm. wide, with ronnded ends ; 
iodoform gauze; iodoform ether 1:10. 

Technic. After the skin has been shaved over an area 
having a radius of 5 to 6 cm. from the wound, the suture 
needle is inserted 2 to 3 cm. from the lips through the skin 
and subjacent tissues, a strong drainage tube, d' , passed 



ij,-r?-i^-,yk5as^t«^&^*(^^ ■■ 




Fig. 14. 

Splint Bandage 

d, d\ d^\ drainage tubes; e, retention suture (closed end); e^ , do, 
open end \J, iodoform gauze ; s, spHnis. 

through the closed end of the suture and the thread drawn 
tight. If before threading the needle a clove hitch is made 
at the middle of the thread, or if threaded as above directed 
and the thread is thrown about the tube in a double noose, 
the two threads will be kept in contact as tlie}^ leave the tube 
and enter the soft tissues and thus prevent to some degree, 
the pressure necrosis otherwise taking place, due to the tense 



THE BAYER SUTURE. i8i 

threads of the suture separating from each other. The 
needle is then passed through the opposite lip of the wound 
from within to without at tlie same distance from the lips, 
the needle removed, the free ends drawn taut and a single 
knot tied against the skin to prevent the separation of the 
two threads for the reasons just stated above, the second 
large drainage tube, d" , is laid between the open ends of 
the double silk thread and these are tied upon it with a 
triple knot, after they have been drawn sufficiently tight 
that the approximated wound lips form a crest. If the lips 
of the wound can be grasped with the hand and held to- 
gether in such a manner as to form a ridge 3 or 4 cm. high, 
the suture needle can be passed through both simultaneousl}' . 
The first suture should be located about 3 cm. beneath the 
upper angle of the wound, the other retention sutures follow 
at distances of about 5 cm. from each other and applied in 
the same way. The lips of the wound are united by contin- 
uous approximation sutures like an overcasted seam. This 
suture ends at least 2 cm. above the lower angle of the 
wound. The third drainage tube is introduced into the 
latter and fixed by a special suture. The entire cutaneous 
surface lying between the drainage tubes is covered with 
iodoform gauze, and between each two retention sutures 
there is laid over this gauze the wooden splints previously 
cut to the proper size, the ends of which are shoved under 
the tubing. The upper- and lowermost splints should be se- 
cured to the drainage tubing by means of sutures passed 
through them. The entire bandage is finally saturated with 
iodoform ether. The bandage and retention sutures remain 
eight days, the approximation sutures fourteen. 



II. EMBRYOTOMY OPERATIONS. 

General Considerations. The following exercises in 
embryotomy operations are designed to giv^e to the stndent 
a general view of the subject by a simple plan as carried 
out through the aid of a skeleton provided with an artificial 
uterus into w^hich are placed freshly killed, newly born 
calves in such a position as may be desired and the opera- 
tions carried out by the student as described. At the same 
time it is hoped to olTer through these descriptions to the 
veterinary obstetrist a simple and effective plan for perform- 
ing embryotomy which has been fully tested by the author 
in an extensive obstetrical practice. In describing these 
operations we purposely limit the instruments to be used to 
the fewest number and simplest kinds, yet using all that are 
essential in the performance of au}^ of the following obstet- 
rical operations. We designate the same instruments for 
each operation. They are : a hooked ring knife ; a Colin 's 
.scalpel like Fig. ii ; an embryotomy chisel i m. in length, 
the handle 1.5 cm. in diameter with a ring end, the blade 
about 10 cm. long by 4 cm. wide and 2 to 3 mm. thick, the 
cutting edge concave from side to side and the corners dull 
and rounded ; mallet ; several cotton ropes i cm. in diame- 
ter with a small spliced loop at one end. 



45. CEPHAI.OTOMY 



Object. The diminution of the size of the head on ac- 
count of its oversize or of the smallness of the maternal 
pelvis, so that it wall pass through the pelvic canal. 

Technic. In these cases the head is usually engaged in 
the canal sufficiently tight that no further fixation is neces- 
sary. After thoroughly cleansing and disinfecting the parts 



1 84 CEPHALOTOMY. 

inject a copious amount of tepid lysol solution into the va- 
gina, then carry thr chisel carefully guarded by one hand into 
the passage and place it accurately upon that part of the head 
of the foetus where it is desired to begin the operation ; 
generall}" on the median line of the nose with the blade of 
the chisel standing parallel to the septum nasi of the fetus. 
Holding the blade of the chisel firmly against the part with 
one hand in such a manner as to effectively guard the in- 
strument from slipping aside and wounding the maternal 
organs, steady and direct the handle with the other hand 
and have an assistant drive the chisel by means of blows of 
proper vigor with the mallet into the bones of the face and 
head. Do not drive the chisel deeper than the length of 
the blade without stopping and forcibly revolving the chisel 
upon its long axis and breaking the foetal bones apart. 
The partially detached pieces of bone may be torn away 
with the fingers or in case the skin is quite adherent to them 
the bone may be held with the fingers of one hand, the 
chisel introduced with the other and using it as a spatula 
separate the skin from the bone. Repeat the use of the 
chisel as often as may be necessary in order to bring about 
the required diminution of the head, care being taken at 
all times to not wound the maternal parts and to conserve as 
far as practicable the skin of the face and head in order that 
it may protect the maternal parts from the jagged bones 
during the passage of the remains of the head. The re- 
moval of the partially detached pieces of bone may in many 
cases be greatly facilitated by looping one of the cords over 
them and having an assistant apply traction sufficient to pull 
them away, the operator guarding the maternal organs by 
holding the piece of bone during its detachment and extrac- 
tion, in the palm of his hand. 



DEC A PITA TION. 1 85 



46. DECAPITATION. 



Objects. The facilitation of repulsion and correction of 
deviation of fetal parts. The operation is generally carried 
out when the foetal head is far advanced in the pelvic canal 
or has passed beyond the vulva. 

Technic. Attach a cord to the inferior maxilla or around 
the neck of the foetus and have one or more assistants draw 
the head out as far as possible. Make a circular incision 
through the skin encircling the head at a convenient point 
and separate the skin backward toward the occiput by forc- 
ing the hand between it and the bones or by using the chisel 
as a spatula or dissecting it away with the Colin's scalpel, 
continuing the separation over the occiput to the atloid 
region. Make a transverse incision below across the trachea 
and oesophagus and surrounding nuisclesand above through 
the ligamentum nuchae. Grasp the head firmly with both 
hands and twist it forcibly on its long axis rupturing the 
articular ligaments and the remaining muscles and other soft 
tissues, detaching the head at tlie occipito-atloid articulation. 
The removal of the head greatly diminishes the bulk of the 
foetus and it may now be repelled, or deviated parts brought 
into the desired position or other operations performed. 



47. SUBCUTANEOUS AMPUTATION OF ANTERIOR LIMB. 

Objects. Amputation of the anterior limbs is very 
frequently called for in obstetric practice especially in 
the mare, chiefly in cases of transverse presentation with 
all four feet presenting where it may be impossible to safely 
correct the deviation, in cases of wry neck in the foal in the 
anterior presentation, dorso-sacral position when it is impos- 
sible to correct the deviation of the head or in any case in 
the mare or cow where deviation of the head cannot 



1 86 SUBCUTANEOUS AMPUTATION. 

be corrected or is not so readily overcome as is the amputa- 
tion of tlie limb. 

Technic. Our larger herbivorous animals being devoid 
of a clavicle, the anterior limb is attached to the thoiax by 
means of the skin and muscles only and is therefore compar- 
atively easily amputated. Attach a cord to the pastern of the 
limb, the shoulder of which lies most exposed or is most 
readily reached and have one or two assistants exert traction 
on it and draw the limb out as far as possible with safety to the 
mother. Insert one hand armed with the hooked embry- 
otomy knife up to the top of the scapula or as nearly thereto 
as can be reached, the knife being well guarded in the palm 
of the hand which rests against the limb of the foetus ; press 
the knife into the skin and subcutaneous tissues and drawing 
the hand downward slit them freely and deeply from the top 
of the scapula down to the pastern. Lay aside the knife and 
force the fingers between the skin and subjacent tissues of 
the limb and while the assistant maintains gentle traction 
upon the limb separate the skin upward by forcing the hand 
or the ball of the thumb through the loose connective tissues 
until the upper region of the scapula is reached. The sepa- 
ration of the skin from the subjacent parts may require at 
certain points, like the olecranon or carpus, the aid of the 
chisel or knife to divide firm bands of connective tissue. 
This separation of the skin from the subjacent parts has re- 
moved the chief source of resistance to the tearing of the 
limb away from the body. The next most important obstacle 
is the pectoral muscles which should be torn asunder by 
separating them into small bundles and tearing them through 
with the fingers between the sternum and limb, or the pro- 
cess may be aided by incision with a knife or with the chisel. 
When these are well divided the remaining impediments to 
tearing the shoulder away consists largely of the trapezius 
and rhomboldeus muscles at the top, the latissimus dorsi be- 
hind and the great serratus and the angularis scapula which 



HUMERO-RADIAL AMPUTATION. 187 

only come into action when the shoulder is nearly severed. 
It is only necessary then to separate the skin from the limb 
and divide the pectoral muscles in order to readily draw the 
limb away by traction. Divide the skin now around the 
pastern and have two or three assistants exert traction upon 
the limb while the operator places his hand against the 
sternum and pushes in the opposite direction. The impact 
upon the maternal organs due to the traction may be re- 
duced to almost any desired degree by applying a repelling 
force to the sternum of the fetus so that the impact upon 
the maternal organs equals the difference between the trac- 
tion applied upon the cord and the repulsion applied to the 
fetal sternum. If traction does not bring the limb away 
promptly tlie operator should attempt to extend the division 
of the muscles attaching the limb totlie thorax while moder- 
ate traction upon the limb is continued. Further diminution 
of the size of the fetus may now^ be had by removal of the 
other limb in the .same way which is especially desirable in 
the transverse presentation of all four limbs in the pa.s.sages 
or we may reduce the size of the trunk by evisceration as 
described under 53. 

This diminution suffices to permit the remnant of the 
fetus to be withdrawn with the head deviated to the side, 
the total resistance being no greater than had the head and 
neck presented normall3^ This diminution also makes the 
foetal body very flaccid, rendering it easy of repulsion and 
simplifies the correction of deviations of any parts. 



48. AMPUTATION AT HUMERO-RADIAL ARTICULATION. 

Object. Amputation at this point is rarely desirable, but 
may at times be necessary in the mare in order to remove 
an anterior limb when it is impossible, on account of the 
position to reach the shoulder. 

Technic Attach a cord to the pastern and have an 



1 88 DETR UNCA TION. 

assistant render the leg tense by exerting moderate traction, 
as in the preceding. Introdnce the hand armed with the 
embryotomy knife, carefully concealed in the palm, and 
girdle the skin around the articulation. Passing above the 
head of the olecranon on the posterior side, divide the 
attachment of the anconean group of muscles with the 
knife by cutting from behind forward. Then divide 
transversely, as far as possible, the muscles and ligaments 
passing over the articulation. Rotate the limb forcibly on 
its long axis while strong traction is maintained, and rup- 
ture the principal ligaments until the limb is completely 
detached and comes away. In cases of limited room it ma}^ 
sometimes be easier to detach the skin of the limb from the 
pastern up to the articulation, as in the preceding chapter, 
rather than to girdle the skin at the articulation. 



49. DETRUNCATION. 
PI.ATE XXX. 

Object. In case a fetus in the anterior presentation and 
dorso-sacral position has one or both posterior limbs devi- 
ated forward and the feet engaged in or against the pubis, 
it is necessary, or at least advisable in the mare, that the 
trunk of the fetus be divided in order to bring about delivery 
without serious or fatal injury to the mother. 

Technic. Secure the two hind feet by means of cords, 
if possible, prior to other manipulations. Apph^ cords to 
the two anterior limbs and the head, have one or two assist- 
ants draw the anterior part of the fetus as far out as is prac- 
ticable and safe, and then girdle the foetal body immediately 
against the maternal vulva by making an incision through 
the skin and skin muscle. If practicable it is best at this 
point to remove one shoulder subcutaneously, 47, and fol- 
low with evisceration, 53, in order to give greater operative 
room and increased mobility of the foetus. Insinuate the 







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192 DESTRUCTION OF THE PELVIC GIRDLE. 

hand between the skin and the deeper structures and forcibly 
separate it from the foetal body backward until the last rib 
is passed, as shown at the curved line on the posterior border 
of the last foetal rib in Plate XXX. Force the finger 
tips through the abdominal wall behind the last rib and 
passing along the entire border of each posterior rib, separate 
the abdominal walls from the ribs and sternum. After the 
abdominal muscles have been detached from the posterior 
ribs and sternum, and the foetus has been eviscerated, rotate 
the thorax upon its long axis which will cause a division of 
the vertebral column near the dorso-lumbar articulation and 
the anterior portion of the foetus falls away. Secure the 
two posterior feet with cords, unless this has already been 
done, spread the detached skin which has been pushed back 
from the thorax, carefully over the amputation stump of the 
lumbar vertebrae, repel these by means of the hand while 
an assistant draws upon the cords attached to the feet, push 
the remnant of the foetal trunk into the uterus and advance 
the feet along the genital passages, thus converting the 
remnant into a posterior presentation. Ordinarily this 
would result in a lumbo-pubic, which should be converted 
into the lumbo-sacral position when its extraction can be 
readily brought about. 



50. DESTRUCTION OF THE PELVIC GIRDLE IN THE 
ANTERIOR PRESENTATION. 

Pi. ATE XXXI. 

Object. In somewhat rare instances perhaps more fre- 
quently in the cow the pelves of the mother and foetus be- 
come interlocked, the antero-external angle of the foetal 
ilium I', becoming locked with the shaft of the maternal 
ilium I at C in such a manner that any safe degree of trac- 
tion fails to dislodge it. 

Technic. Remove one anterior limb subcutaneously, 47, 
and eviscerate, 53, through an opening made by the removal 





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196 AMPUTATION OF THE LIMBS AT THE TARSUS. 

of two or three of the exposed ribs. Introduce the chisel 
through this opening and carry it back with the hand, 
placing it against the shaft of the fetal ilium, I', have an 
assistant drive it through the shaft from before to behind 
and then withdrawing the chisel replace it against the pubic 
brim either at the symph^'sis pubis or opposite the foramen 
ovale, and drive it through the pubis and ischium at either of 
these points. Tiie coxo-femoral articulation is thus detached 
and isolated so that the entire limb may drop backward 
beyond its fellow, the remnant of the severed ilium, I', can 
drop downward or move in any direction and the entire pel- 
vis thus loses its rigidity and undergoes great diminution in 
size so that it can readily be withdrawn. 



51. AMPUTATION OF THE LIMBS AT THE TARSUS. 
Pr,ATE XXXII. 

Object. It occasionally happens in the mare, far more 
rareh' in the cow in the posterior presentation with the hind 
limbs retained at the hock that owing to the unusual size of 
the fetus or its having been dead for some time, dry and 
emph3\sematous, that the deviation can not be overcome or 
its correction would entail an unnecessary amount of labor. 
In these cases it is frequentl}^ easier for the obstetrist and 
safer for the mother to amputate the limb at the tarsus. 

Technic. Pass a cord around the leg above tlie tarsus 
as indicated in Plate XXXII and have an assistant hold the 
leg steady by gentle traction. Introduce the chisel carefully 
guarded in the palm of the hand , and place it against the lower 
part of the tarsus as shown between TT. The chisel should 
be placed as nearly perpendicular as possible to the long axis 
of the metatarsus. The proper direction of the chisel may at 
times be greatl3^ favored by placing the cord upon the meta- 





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200 INTRA-PEL VIC AMPUTA TION. 

tarsus instead of the leg thus forcing the tarsus toward the 
sacrum of the mother and tending to throw the metatarsus 
straight across the pelvic cavit3\ When the foetus is in the 
lumbo-sacral position and it is desired to amputate the left limb 
the chisel should be held in the palm of the left hand with 
the back of the hand against the vaginal walls and the 
chisel carefully guarded and guided during the entire 
operation. Do not drive the chisel entirely through the 
hock without removal as it may become caught and clamped 
between the divided bones, but drive for a few inches along 
the lateral side being sure that the skin on that side is 
severed along with the bone, then loosen the chisel by rota- 
tion and lateral motion and drive somewhat deeper into the 
tarsus until it is completely severed. Withdraw the severed 
metatarsus and remove any dangerous spicules of bone re- 
maining on the stump and see that the latter is safely se- 
cured by a cord passing around the leg above the os calcis. 
Repeat the operation on the otlier hock in a similar manner 
using the right hand to guide the chisel. Extend the two 
limbs into the passages b}^ traction and effect a posterior 
delivery. 



52. INTRA-PELVIC AMPUTATION OF THE POSTERIOR 
LIMBS, BREECH PRESENTATION. 

Plates XXXIII and XXXIV. 

Uses. The overcoming of dystocia due to a posterior 
presentation with the hind limbs completely retained in the 
uterus, the so-called breech presentation, in cases where the 
deviation can not be readily corrected. 

Technic. Introduce one hand armed with the embry- 
otomy knife through the maternal passages until the peri- 
naeum of the fetus is reached and make a free incision 
through that region involving the anus in the male fetus 
and the anus and vulva in the female and enlarge the 







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204 INTRA-PEL VIC AMPUTA TION. 

incision sufficiently to admit the operator's hand into the 
fetal pelvis. lyocate the great sciatic ligament and inserting 
the knife at the shaft of the ilium divide the former back- 
ward to the perinaeum allowing the pelvic cavity to dilate 
freely and giving ample operating room. If the pelvis of the 
fetus is too small to admit the hand of the operator at all be- 
fore severing the sciatic ligament this may be accomplished 
by cautiously cutting from behind forward with Colin 's 
scalpel or with the chisel. When this has been severed and 
sufficient operating room attained carry the chisel with one 
hand and place it against the shaft of the ilium as shown 
between I' V in Plate XXXIII as nearly perpendicular to 
the long axis of the shaft as possible and keeping the hand 
in touch with the chisel blade have an assistant drive it 
through the bone until it and its periosteum are completely 
severed. Disengage the chisel and then place it against the 
symphysis pubis or against the ischium opposite the foramen 
ovale and drive it through the ischium and pubis at this 
point. Using the chisel as a lever, separate the isolated por- 
tion of the pelvis as completely as practicable from the sur- 
rounding tissues, and with the fingers separate the muscles 
from the detached pelvic bone iox a short distance on 
either side from the severed ends. Carry a cord in and 
pass the loop over the ends of the severed section and 
tightening it secure the isolated portion of the pelvis and 
have one or more assistants exert traction upon the cord 
as indicated in Plate XXXIV. The chief obstacle to the 
withdrawal of the limb is the great gluteus muscle which 
should be sought for, identified and torn through with the 
fingers at a distance of 5 or 6 cm. from its attachment to the 
great trochanter. Other important points of resistance are 
the attachment posteriorly of the skin, vulva and anus to 
the ischium through the medium of aponeurosis and anter- 
iorly, chiefly on the median line, the prepubic tendon ; these 
are to be cut, if necessary, with the chisel or knife. Vigor- 



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2o8 INTRA- PEL VIC AM PUT A TION. 

oiis traction may now be applied by means of the cord, the 
operator in the meantime guarding the most advanced end 
of the detached piece of pelvis with the palm of his hand in 
order to prevent injur}^ to the maternal organs. Sometimes 
this detached piece of the pelvis tears away from the femur 
when traction is applied and comes away alone. In such a 
case the cord is to be applied over the head and trochanter 
of the femur and traction again applied drawing the limb 
away in a reversed position, the skin being turned back or 
everted as the limb advances until the region of the hock is 
reached where the skin does not so readily separate from the 
limb and onh^ requires to be cut loose and the limb allowed 
to come away. During the removal of the limb the operator 
is to constantly note the progress with his hand and sever 
by tearing or cutting au}^ tendons or muscles which offer 
special obstruction to the work. Repeat the operation upon 
the opposite limb in the same manner except that but one 
incision need be made through the bone, that is, through the 
shaft of the ilium. During the entire work the operation is 
carried out subcutaneously or rather intrafoetally and the 
maternal parts are amply guarded against injur^^ The size 
of the foetal trunk may be further reduced if desirable, by 
evisceration, 53, and followed still further by the introduction 
of the chisel guided b}^ the hand and the ribs, on one or both 
sides, severed one after another until the chest can completely 
collapse and if need be some of the ribs may be removed and 
one of the anterior limbs caught by a cord around the scap- 
ula and removed intra-foetally. The remnant of the foetus 
is to be extracted by means of a cord fastened about the 

lumbar region of the spine. 



E VISCERA TION. 209 



53. EVISCERATION. 

The evisceration of the foetus is frequently desirable in 
obstetric practice and has a variety of uses. It decreases 
the size of the foetal trunk considerably and permits its more 
read}^ passage through the genital canal, as in the anterior 
presentation ; with lateral deviation of the head it renders the 
foetal trunk flaccid through the removal of the viscera sup- 
porting the body walls and permits the body remnant to be 
bent or moved more readily for the correction of any devia- 
tions present ; it permits freedom of intra-foetal operations 
directed against other parts, as for detruncation, or for the 
destruction of the pelvic girdle in the anterior presentation. 

Technic. Evisceration may ])e variously performed, but 
is generally demanded in either the anterior or posterior 
presentation and a description of these will suffice. 

In the anterior presentation, unless the foetus is far ad- 
vanced through the vulva, evisceration is best performed by 
the removal of one or more of the anterior ribs. The ribs 
are generall}^ best reached by the removal of the shoulder, 
as already described under subcutaneous amputation of the 
anterior limbs, 47. When these have been laid bare in the 
manner descrii^ed the operator can thrust the finger tips 
through the intercostal nuiscles in the first intercostal space 
and enlarge the opening thus made b}- tearing through the 
muscles upwards to the spinal column and downwards to the 
sternum ; then grasping the posterior border of the rib near 
its middle, fracture it by means of a sudden and vigorous 
pull. The fractured ends may then be grasped and pulled, 
broken or twisted off. The chisel may be brought into use 
if required in order to divide the rib, the hand of the opera- 
tor constantly guiding and guarding the chisel blade. The 
operation is then to be repeated if required, upon the second 
and third ribs in the same manner until an opening into the 

14 



2 1 o E VISCERA 770 N. 

chest is secured ample in size for tlie introduction of the 
operator's liaud. 

Force one hand through the opening and tear the niedi- 
astiuni above and below from the thoracic walls, and then 
grasp either the trachea at its bifurcation or the heart and 
tear them avva}^ The heart, which constitutes the greater 
bulk of the thoracic viscera, is best grasped in the palm of 
the hand, with the fingers engaging the aorta and pulmo- 
nary arteries. When the thoracic viscera have been with- 
drawn, thru'^t the fingers through the diaphragm and 
locating the liver, isolate the area of the diaphragm to which 
it is attached, and engaging both with the fingers remove 
the two together. The liver constitutes, in a normal foetus, 
the chief intra-abdominal mass, occupving more space than 
all other organs combined. After the liver has been re- 
moved the intestinal tube, with its contents, are withdrawn 
without difficulty, as its attachments are feeble. The kid- 
neys may also be removed. 

Evisceration in the posterior presentation is preferably 
performed through the pelvis, generally in connection with 
52. It may be performed without destruction of the pelvic 
girdle by making an incision through the perineal region 
and then severing the sacrosciatic ligament as directed 
under 52. When admission has been gained to the abdom- 
inal cavity introduce the hand and withdraw the alimentary 
tube, then rupture the diaphragm about the liver and tear 
away the latter organ in the same manner as in the anterior 
presentation. The liver is so friable that it cannot well be 
torn away by grasping the organ itself, but comes away en- 
tire with the central part of the diaphragm. 

Remove the heart and lungs as above directed. 



SEP 30 1908 



